MEDICARE: DR. MARGARET BALLANTINE MSW, PHD

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	1041C0700X	Clinical Social Worker	R018948-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CX1326054743	OTHER	NY	CROSSROADS IDENTIFIER

General Provider Information

NPI Number	:	1366537250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARGARET BALLANTINE MSW, PHD

Provider Business Mailing Address
First Line	:	123 MARKET ST
Second Line	:
City	:	AMSTERDAM
State	:	NY
Zip	:	12010-3601
Country	:	US
Telephone Number	:	518-843-8440
Fax Number	:

Provider Business Practice Location Address
First Line	:	123 MARKET ST
Second Line	:
City	:	AMSTERDAM
State	:	NY
Zip	:	12010-3601
Country	:	US
Telephone Number	:	518-843-8440
Fax Number	:

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	07/08/2007

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