Provider Demographics
NPI:1073363420
Name:BALASCIO, SARAH J (LCAT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:J
Last Name:BALASCIO
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 GOVERNORS DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-3411
Mailing Address - Country:US
Mailing Address - Phone:180-273-4253
Mailing Address - Fax:
Practice Address - Street 1:105 GOVERNORS DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-3411
Practice Address - Country:US
Practice Address - Phone:180-273-4253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001867221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist