Provider Demographics
NPI:1528205127
Name:BALARA, ALLYSON (MED)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:
Last Name:BALARA
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:489 TURNPIKE ST APT 3-8
Mailing Address - Street 2:
Mailing Address - City:SOUTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02375-2101
Mailing Address - Country:US
Mailing Address - Phone:774-269-9366
Mailing Address - Fax:
Practice Address - Street 1:489 TURNPIKE ST APT 3-8
Practice Address - Street 2:
Practice Address - City:SOUTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02375-2101
Practice Address - Country:US
Practice Address - Phone:774-269-9366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-19
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health