Provider Demographics
NPI:1609158104
Name:BALOGA, ERICA LOREN
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:LOREN
Last Name:BALOGA
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 1:210 PINE ST APT 315
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-8418
Mailing Address - Country:US
Mailing Address - Phone:860-759-8346
Mailing Address - Fax:
Practice Address - Street 1:1007 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:DAYVILLE
Practice Address - State:CT
Practice Address - Zip Code:06241-0839
Practice Address - Country:US
Practice Address - Phone:860-774-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist