Provider Demographics
NPI:1881804367
Name:BALLINGER, ANNEMARIE
Entity type:Individual
Prefix:
First Name:ANNEMARIE
Middle Name:
Last Name:BALLINGER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ANNEMARIE
Other - Middle Name:
Other - Last Name:BALLINGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:3103 BIRDSALL AVE.
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619
Mailing Address - Country:US
Mailing Address - Phone:510-713-8437
Mailing Address - Fax:510-536-6334
Practice Address - Street 1:38970 BLACOW RD
Practice Address - Street 2:SUITE C
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-7380
Practice Address - Country:US
Practice Address - Phone:510-713-8437
Practice Address - Fax:510-536-6334
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33769106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10941386Medicare UPIN