Provider Demographics
NPI:1306919170
Name:KAYES, BARRY L (EDD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:L
Last Name:KAYES
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8040 ROOSEVELT BOULEVARD
Mailing Address - Street 2:SUITE 217
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-2902
Mailing Address - Country:US
Mailing Address - Phone:215-268-0002
Mailing Address - Fax:866-447-8680
Practice Address - Street 1:8040 ROOSEVELT BOULEVARD
Practice Address - Street 2:SUITE 217
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19152-2902
Practice Address - Country:US
Practice Address - Phone:215-268-0002
Practice Address - Fax:866-447-8680
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS001864103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA072594OtherFED EMPLOYEE PROGRAM BCBS
PA0062922000OtherPERSONAL CHOICE
PA001664389OtherKHPE
PA5357116OtherAETNA
PA298412000OtherMAGELLAN
PA72594Medicare ID - Type Unspecified