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General NPI Number Information
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NPI Number | 1164776431
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Entity Type | Individual
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Provider Name | BONNIE LYNN BALSAMO LICSW
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Gender | Female
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Dates
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Enumeration Date | 11/07/2012
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Last Update Date | 02/15/2024
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Provider Practice Location Address
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Address Line | 141 CORLISS LN
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City | COLEBROOK
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State | NH
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Zip | 03576-3206
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Country | US
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Telephone | 603-788-5075
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Fax | 37-885-2856
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Provider Business Mailing Address
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Address Line | 173 MIDDLE ST
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City | LANCASTER
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State | NH
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Zip | 03584-3508
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Country | US
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Telephone | 603-788-5029
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Fax | 603-788-5607
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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 | 089.0127277
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License Number State | VT
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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 | 8970
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 118984
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2009
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License Number State | NH
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