Provider Demographics
NPI:1750430120
Name:BARRY, AMY JAO
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:JAO
Last Name:BARRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:JAO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICAC, MAC
Mailing Address - Street 1:1 RAMPARTS FIELD RD
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-4413
Mailing Address - Country:US
Mailing Address - Phone:978-282-0318
Mailing Address - Fax:
Practice Address - Street 1:65 EASTERN AVE
Practice Address - Street 2:ATLANTIC WELLNESS CENTER
Practice Address - City:ESSEX
Practice Address - State:MA
Practice Address - Zip Code:01929-1300
Practice Address - Country:US
Practice Address - Phone:978-768-6321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205909171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist