Provider Demographics
NPI:1104063759
Name:BARTEN, IRIS WERBALOWSKY (M ED; LMHC, LMFT)
Entity type:Individual
Prefix:MS
First Name:IRIS
Middle Name:WERBALOWSKY
Last Name:BARTEN
Suffix:
Gender:F
Credentials:M ED; LMHC, LMFT
Other - Prefix:MS
Other - First Name:IRIS
Other - Middle Name:W
Other - Last Name:BARTEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SAME & LCSW BOTH
Mailing Address - Street 1:PO BOX 173
Mailing Address - Street 2:
Mailing Address - City:BOLTON
Mailing Address - State:MA
Mailing Address - Zip Code:01740-0173
Mailing Address - Country:US
Mailing Address - Phone:978-779-2744
Mailing Address - Fax:
Practice Address - Street 1:35 VAUGHN HILL RD
Practice Address - Street 2:
Practice Address - City:BOLTON
Practice Address - State:MA
Practice Address - Zip Code:01740-1050
Practice Address - Country:US
Practice Address - Phone:978-779-2744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-17
Last Update Date:2009-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA899101YM0800X
MA208205 2104100000X
MA532106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA70010000LM0622OtherBCBSMA