Provider Demographics
NPI:1629258280
Name:BALCAZAR, DAWN (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:
Last Name:BALCAZAR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 COTTAGE ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-6948
Mailing Address - Country:US
Mailing Address - Phone:508-740-5175
Mailing Address - Fax:
Practice Address - Street 1:572 WASHINGTON ST
Practice Address - Street 2:SUITE 4
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-6418
Practice Address - Country:US
Practice Address - Phone:508-740-5175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-11
Last Update Date:2007-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4659103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical