Provider Demographics
NPI:1922693266
Name:BARRY, SHAWN (LMFT)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:BARRY
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-1164
Mailing Address - Country:US
Mailing Address - Phone:650-363-4030
Mailing Address - Fax:
Practice Address - Street 1:2415 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:EAST PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-1164
Practice Address - Country:US
Practice Address - Phone:650-363-4030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA124456106H00000X
CALMFT149162106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist