Provider Demographics
NPI:1205302742
Name:BALESTRACCI, JENNIFER MORWAY (LICSW, SAC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MORWAY
Last Name:BALESTRACCI
Suffix:
Gender:F
Credentials:LICSW, SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 TOWER HILL RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01540-2613
Mailing Address - Country:US
Mailing Address - Phone:508-248-5971
Mailing Address - Fax:508-248-4747
Practice Address - Street 1:57 OLD MUGGETT HILL RD
Practice Address - Street 2:
Practice Address - City:CHARLTON
Practice Address - State:MA
Practice Address - Zip Code:01507-1331
Practice Address - Country:US
Practice Address - Phone:508-248-5971
Practice Address - Fax:508-248-4747
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1387037101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool