Provider Demographics
NPI:1417933607
Name:BARRY, KRISTEN ELIZABETH (PHD)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:ELIZABETH
Last Name:BARRY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KRIS
Other - Middle Name:EG
Other - Last Name:BARRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:109 STATE ST STE 6
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5343
Mailing Address - Country:US
Mailing Address - Phone:530-925-4673
Mailing Address - Fax:207-573-7639
Practice Address - Street 1:109 STATE ST STE 6
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5343
Practice Address - Country:US
Practice Address - Phone:530-925-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 20144103TC0700X
ME1616103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical