Healthcare Provider Details

I. General information

NPI: 1073295465
Provider Name (Legal Business Name): AMY JOY BALMANNO NCSP, LEP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2023
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1752 E BULLARD AVE STE 101
FRESNO CA
93710-5864
US

IV. Provider business mailing address

7596 N VISTA AVE
FRESNO CA
93722-2207
US

V. Phone/Fax

Practice location:
  • Phone: 559-448-7128
  • Fax:
Mailing address:
  • Phone: 559-448-7128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLEP3747
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: