MEDICARE: MRS. MARIA LOUISE BALINTONA LICSW

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	I-05027	NM
2	1041C0700X	Clinical Social Worker	2988	ND
3	1041C0700X	Clinical Social Worker	13716	MN

General Provider Information

NPI Number	:	1740270339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIA LOUISE BALINTONA LICSW

Provider Business Mailing Address
First Line	:	1702 UNIVERSITY DR S
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58103-4940
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1702 UNIVERSITY DR S
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58103-4940
Country	:	US
Telephone Number	:	701-364-3300
Fax Number	:	701-364-8906

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

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	11/25/2024

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