Provider Demographics
NPI:1487945796
Name:DR. DUSTAN A BARABAS P.C.
Entity type:Organization
Organization Name:DR. DUSTAN A BARABAS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSTAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BARABAS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:570-629-4900
Mailing Address - Street 1:930 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-1208
Mailing Address - Country:US
Mailing Address - Phone:570-629-4900
Mailing Address - Fax:570-420-1248
Practice Address - Street 1:930 N 9TH ST
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360
Practice Address - Country:US
Practice Address - Phone:570-629-4900
Practice Address - Fax:570-420-1248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-21
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016559103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001965985Medicaid
PA001965985Medicaid