Healthcare Provider Details

I. General information

NPI: 1942899737
Provider Name (Legal Business Name): ARTHUR DONALD BALTHAZAR LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2021
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 ARCHER ST
FALL RIVER MA
02720-6546
US

IV. Provider business mailing address

415 ARCHER ST
FALL RIVER MA
02720-6546
US

V. Phone/Fax

Practice location:
  • Phone: 508-333-7113
  • Fax: 508-672-6512
Mailing address:
  • Phone: 508-333-7113
  • Fax: 508-672-6512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number101024
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: