MEDICARE: ALYSSA LAUREN BALASCO LCSW

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	101YM0800X	Mental Health Counselor	ASW89579	CA
2	1041C0700X	Clinical Social Worker	113260	CA

General Provider Information

NPI Number	:	1306409941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA LAUREN BALASCO LCSW

Provider Business Mailing Address
First Line	:	7699 PALMILLA DR APT 3412
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-5098
Country	:	US
Telephone Number	:	401-556-9810
Fax Number	:

Provider Business Practice Location Address
First Line	:	7699 PALMILLA DR APT 3412
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-5098
Country	:	US
Telephone Number	:	401-556-9810
Fax Number	:

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

Provider Enumeration Date	:	04/18/2019
Last Update Date	:	06/27/2024

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