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NPI Code Detail

MEDICARE: MR. DENNIS BALCOM MSW

MEDICARE: MR. DENNIS BALCOM 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
11041C0700XClinical Social Worker100275MA

General Provider Information

NPI Number : 1891785812
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DENNIS BALCOM MSW
Provider Business Mailing Address
First Line : 263 CONCORD AVE # 1
Second Line :
City : CAMBRIDGE
State : MA
Zip : 02138-1336
Country : US
Telephone Number : 617-661-1358
Fax Number : 617-661-1359
Provider Business Practice Location Address
First Line : 263 CONCORD AVE # 1
Second Line :
City : CAMBRIDGE
State : MA
Zip : 02138-1336
Country : US
Telephone Number : 617-661-1358
Fax Number : 617-661-1359
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2005
Last Update Date : 05/14/2010

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