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Individual
MRS. SUSAN J. BALLARD
Active
Individual
MRS. SUSAN J. BALLARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.I.C.S.W.
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
005058
CT
1041C0700X
Clinical Social Worker
Primary
113142
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11241180
CAQH PROVIDER ID
MA
01
—
3248367
AETNA PROVIDER ID
CT
01
—
403426
MAGELLAN PROVIDER ID
MA
Enumeration date
03/04/2007
Last updated
07/08/2007
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