Provider Demographics
NPI:1376752089
Name:BALLANTYNE, LUCINDA JANE (MSW)
Entity Type:Individual
Prefix:MS
First Name:LUCINDA
Middle Name:JANE
Last Name:BALLANTYNE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:LUCINDA
Other - Middle Name:B
Other - Last Name:LAFRENIERE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:12 FAIR OAKS DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-6938
Mailing Address - Country:US
Mailing Address - Phone:781-863-8437
Mailing Address - Fax:
Practice Address - Street 1:1493 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1047
Practice Address - Country:US
Practice Address - Phone:617-575-5965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical