MEDICARE: LAURA BALTZELL MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	1022672	MA

General Provider Information

NPI Number	:	1093888497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA BALTZELL MSW

Provider Business Mailing Address
First Line	:	59 CARMEL HILL RD N
Second Line	:
City	:	BETHLEHEM
State	:	CT
Zip	:	06751-1602
Country	:	US
Telephone Number	:	781-308-2259
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 RESERVOIR OFFICE PARK
Second Line	:	STE 204
City	:	SOUTHBURY
State	:	CT
Zip	:	06488-3926
Country	:	US
Telephone Number	:	781-308-2259
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	03/31/2021

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