Provider Demographics
NPI:1275719940
Name:BALAGUE, GLORIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:
Last Name:BALAGUE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 W HARRISON ST
Mailing Address - Street 2:3018 BSB
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-7135
Mailing Address - Country:US
Mailing Address - Phone:312-996-8681
Mailing Address - Fax:312-413-4721
Practice Address - Street 1:1007 W HARRISON ST
Practice Address - Street 2:3018 BSB
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-7135
Practice Address - Country:US
Practice Address - Phone:312-996-8681
Practice Address - Fax:312-413-4721
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-12
Last Update Date:2008-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist