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General NPI Number Information
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NPI Number | 1144359456
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Entity Type | Individual
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Provider Name | SUSAN J. BALLARD L.I.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 03/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 632 WESTFIELD ST
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City | WEST SPRINGFIELD
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State | MA
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Zip | 01089-3887
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Country | US
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Telephone | 413-231-3094
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Fax | 413-455-1265
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Provider Business Mailing Address
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Address Line | 28 POPLAR AVE
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City | WEST SPRINGFIELD
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State | MA
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Zip | 01089-2925
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Country | US
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Telephone | 413-231-3094
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Fax | 413-455-1265
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 113142
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 005058
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License Number State | CT
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