Provider Demographics
NPI:1962577270
Name:BARROS, GWENDOLYN JANE (MD)
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:JANE
Last Name:BARROS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HANOVER STREET, SUITE 2
Mailing Address - Street 2:WEST CENTRAL SERVICES, INC.
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766
Mailing Address - Country:US
Mailing Address - Phone:603-448-0126
Mailing Address - Fax:603-448-6001
Practice Address - Street 1:140 NORTH ST
Practice Address - Street 2:RECOVERY CTR COUNSELING CTR
Practice Address - City:CLAREMONT
Practice Address - State:NH
Practice Address - Zip Code:03743
Practice Address - Country:US
Practice Address - Phone:603-542-2578
Practice Address - Fax:603-542-5456
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH94432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
BARE3816Medicare ID - Type Unspecified
G10274Medicare UPIN