Provider Demographics
NPI:1518490846
Name:BALOGA, LUCILLE (MA, MED)
Entity Type:Individual
Prefix:
First Name:LUCILLE
Middle Name:
Last Name:BALOGA
Suffix:
Gender:F
Credentials:MA, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 ABBY RD
Mailing Address - Street 2:
Mailing Address - City:FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:18615-7772
Mailing Address - Country:US
Mailing Address - Phone:570-881-7966
Mailing Address - Fax:
Practice Address - Street 1:167 ABBY RD
Practice Address - Street 2:
Practice Address - City:FALLS
Practice Address - State:PA
Practice Address - Zip Code:18615-7772
Practice Address - Country:US
Practice Address - Phone:570-881-7966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004991L103T00000X
PA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool