Provider Demographics
NPI:1548422447
Name:BALSA, RAMON DAVID (MA)
Entity Type:Individual
Prefix:MR
First Name:RAMON
Middle Name:DAVID
Last Name:BALSA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5727 QUAIL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332-7843
Mailing Address - Country:US
Mailing Address - Phone:787-645-1069
Mailing Address - Fax:
Practice Address - Street 1:5727 QUAIL RIDGE DR
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27332-7843
Practice Address - Country:US
Practice Address - Phone:787-645-1069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2019-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2933103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling