Basic Information
| Provider Information | |||||||||
| NPI: | 1427671353 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALESTRACCI | ||||||||
| FirstName: | KATHRYN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 47 TOWN ST | ||||||||
| Address2: | |||||||||
| City: | NORWICH | ||||||||
| State: | CT | ||||||||
| PostalCode: | 063602323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8608927042 | ||||||||
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| Practice Location | |||||||||
| Address1: | 47 TOWN ST | ||||||||
| Address2: | |||||||||
| City: | NORWICH | ||||||||
| State: | CT | ||||||||
| PostalCode: | 063602323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8608927042 | ||||||||
| FaxNumber: | 8608927043 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2020 | ||||||||
| LastUpdateDate: | 02/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 11026 | CT | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.