Provider Demographics
NPI:1760974281
Name:BALCERAK, LAURA MARIE (PSS)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:BALCERAK
Suffix:
Gender:F
Credentials:PSS
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:MARIE
Other - Last Name:LOUVIERE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:225 MIA DR
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:LA
Mailing Address - Zip Code:70359-5317
Mailing Address - Country:US
Mailing Address - Phone:985-790-0486
Mailing Address - Fax:
Practice Address - Street 1:303 HICKORY ST
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-2011
Practice Address - Country:US
Practice Address - Phone:985-228-2068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist