Provider Demographics
NPI:1881739373
Name:BARKSTROM, SCOTT (PHD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:BARKSTROM
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 1:241 NORTH ROAD
Mailing Address - Street 2:SAINT FRANCIS HOSPITAL
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601
Mailing Address - Country:US
Mailing Address - Phone:845-431-8287
Mailing Address - Fax:845-485-4113
Practice Address - Street 1:241 NORTH ROAD
Practice Address - Street 2:SAINT FRANCIS HOSPITAL
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601
Practice Address - Country:US
Practice Address - Phone:845-431-8287
Practice Address - Fax:845-485-4113
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013681103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY013681OtherLICENSE