MEDICARE: MS. JENNIFER BALSAN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CW017821	PA

General Provider Information

NPI Number	:	1144636465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER BALSAN LCSW

Provider Business Mailing Address
First Line	:	836 TIMBER LN
Second Line	:
City	:	DRESHER
State	:	PA
Zip	:	19025-1827
Country	:	US
Telephone Number	:	908-399-8868
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 E GLENSIDE AVE
Second Line	:
City	:	GLENSIDE
State	:	PA
Zip	:	19038-4618
Country	:	US
Telephone Number	:	908-399-8868
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2014
Last Update Date	:	07/08/2014

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