Provider Demographics
NPI:1215418454
Name:BALENO, KIRSTEN H (LICSW, C-SSWS, MED)
Entity Type:Individual
Prefix:MRS
First Name:KIRSTEN
Middle Name:H
Last Name:BALENO
Suffix:
Gender:F
Credentials:LICSW, C-SSWS, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 HANDEL RD
Mailing Address - Street 2:
Mailing Address - City:BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01821-3719
Mailing Address - Country:US
Mailing Address - Phone:781-799-4264
Mailing Address - Fax:
Practice Address - Street 1:15 BOW ST
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-3427
Practice Address - Country:US
Practice Address - Phone:978-808-7475
Practice Address - Fax:978-536-5860
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-26
Last Update Date:2018-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1111581041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool