Provider Demographics
NPI:1497152466
Name:BALDASARO, KIMBERLY ANN
Entity Type:Individual
Prefix:
First Name:KIMBERLY ANN
Middle Name:
Last Name:BALDASARO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-3023
Mailing Address - Country:US
Mailing Address - Phone:781-247-0076
Mailing Address - Fax:781-449-7972
Practice Address - Street 1:255 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-3023
Practice Address - Country:US
Practice Address - Phone:781-247-0076
Practice Address - Fax:781-449-7972
Is Sole Proprietor?:No
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist