Provider Demographics
NPI:1972720191
Name:BARNETT, VICKI ALISA (PSYD)
Entity type:Individual
Prefix:DR
First Name:VICKI
Middle Name:ALISA
Last Name:BARNETT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 JONES RD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4411
Mailing Address - Country:US
Mailing Address - Phone:201-541-5596
Mailing Address - Fax:
Practice Address - Street 1:288 JONES RD
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4411
Practice Address - Country:US
Practice Address - Phone:201-541-5596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ545913Medicare ID - Type UnspecifiedMEDICARE
NJ099039Medicare UPIN