Provider Demographics
NPI:1871868430
Name:BALDASSARI, JOANNE ADELE (MSW)
Entity Type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:ADELE
Last Name:BALDASSARI
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:CT
Mailing Address - Zip Code:06237-0097
Mailing Address - Country:US
Mailing Address - Phone:860-228-3347
Mailing Address - Fax:860-228-3347
Practice Address - Street 1:45 BAXTER RD
Practice Address - Street 2:
Practice Address - City:STORRS
Practice Address - State:CT
Practice Address - Zip Code:06268-1109
Practice Address - Country:US
Practice Address - Phone:860-208-3506
Practice Address - Fax:860-228-3347
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000554104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker