Provider Demographics
NPI:1366265787
Name:BARRIOS, HUMBERTO JACKIE
Entity type:Individual
Prefix:
First Name:HUMBERTO
Middle Name:JACKIE
Last Name:BARRIOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:666 BROAD ST APT 5
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-4376
Mailing Address - Country:US
Mailing Address - Phone:475-235-8191
Mailing Address - Fax:
Practice Address - Street 1:77 HARTLAND ST STE 108
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-3259
Practice Address - Country:US
Practice Address - Phone:860-385-2390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician