Provider Demographics
NPI:1770924425
Name:BAILLARGEON, AMANDA JOY
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JOY
Last Name:BAILLARGEON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 WHITES AVE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-3722
Mailing Address - Country:US
Mailing Address - Phone:978-443-7538
Mailing Address - Fax:
Practice Address - Street 1:54 MIDDLESEX TPKE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4908
Practice Address - Country:US
Practice Address - Phone:781-893-2003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-10
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1204041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical