Provider Demographics
NPI:1679132310
Name:MARTHA BARCELOS APRN, PMHNP, LLC
Entity type:Organization
Organization Name:MARTHA BARCELOS APRN, PMHNP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BARCELOS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:860-329-9928
Mailing Address - Street 1:39 MADISON LN
Mailing Address - Street 2:
Mailing Address - City:WEST SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06092-2615
Mailing Address - Country:US
Mailing Address - Phone:860-803-4127
Mailing Address - Fax:
Practice Address - Street 1:779 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1674
Practice Address - Country:US
Practice Address - Phone:860-329-9928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty