Provider Demographics
NPI:1629028899
Name:BALBONI DALY, BARBARA
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:BALBONI DALY
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 1:747 MAIN ST
Mailing Address - Street 2:STE 111
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-3326
Mailing Address - Country:US
Mailing Address - Phone:978-371-1400
Mailing Address - Fax:978-371-0246
Practice Address - Street 1:111 OLD ROAD TO 9 ACRE COR
Practice Address - Street 2:SUITE 490
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-4141
Practice Address - Country:US
Practice Address - Phone:978-371-1400
Practice Address - Fax:978-371-0246
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA349231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAD0108OtherBLUE CROSS BLUE SHIELD
MA033164Medicare PIN
P59035Medicare UPIN