Provider Demographics
NPI:1972729135
Name:BALTZER, CAROLINE ROBINSON (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:ROBINSON
Last Name:BALTZER
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 1:158 MOUNT AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-4876
Mailing Address - Country:US
Mailing Address - Phone:617-547-8040
Mailing Address - Fax:617-547-8040
Practice Address - Street 1:158 MOUNT AUBURN ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4876
Practice Address - Country:US
Practice Address - Phone:617-547-8040
Practice Address - Fax:617-547-8040
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7404103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5725-01OtherPACIFICARE PROVIDER ID
MAW05754OtherBCBSMA PROVIDER NUMBER
MA5725-01OtherPACIFICARE PROVIDER ID