Provider Demographics
NPI:1154163087
Name:BARTLEY, DASHAUN XAVIER I
Entity type:Individual
Prefix:
First Name:DASHAUN
Middle Name:XAVIER
Last Name:BARTLEY
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:673 COLUMBIA RD
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02125-1712
Mailing Address - Country:US
Mailing Address - Phone:617-894-8419
Mailing Address - Fax:
Practice Address - Street 1:673 COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02125-1712
Practice Address - Country:US
Practice Address - Phone:617-894-8419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty