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General NPI Number Information
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NPI Number | 1558485490
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Entity Type | Individual
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Provider Name | BRONWEN B. BALLOU LICSW
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Gender | Female
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Dates
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Enumeration Date | 03/17/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 367 STATE ROUTE 120 SUITE B1
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City | LEBANON
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State | NH
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Zip | 03766-1430
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Country | US
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Telephone | 603-653-0199
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Fax |
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Provider Business Mailing Address
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Address Line | 20 DRESDEN RD
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City | HANOVER
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State | NH
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Zip | 03755-1322
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Country | US
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Telephone | 603-643-8838
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Fax |
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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 | 949
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License Number State | NH
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