Provider Demographics
NPI:1174673263
Name:BARRY, STEVEN PATRICK (PHD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:PATRICK
Last Name:BARRY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 SE 122ND AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-1270
Mailing Address - Country:US
Mailing Address - Phone:503-255-2191
Mailing Address - Fax:503-255-1609
Practice Address - Street 1:1441 SE 122ND AVE
Practice Address - Street 2:SUITE G
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-1270
Practice Address - Country:US
Practice Address - Phone:503-255-2191
Practice Address - Fax:503-255-1609
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0609103TC0700X
103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities