Provider Demographics
NPI:1487030029
Name:BALLERINI, COLLEEN M (LMHC)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:M
Last Name:BALLERINI
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 ROCKY BROOK RD
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-1463
Mailing Address - Country:US
Mailing Address - Phone:978-273-4225
Mailing Address - Fax:
Practice Address - Street 1:3 DUNDEE PARK DR
Practice Address - Street 2:SUITE 203
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-3751
Practice Address - Country:US
Practice Address - Phone:978-475-3590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9292101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health