Provider Demographics
NPI:1124718259
Name:BALAREZO, JACQUELINE ALEXANDRA (MA MENTAL HEALTH)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ALEXANDRA
Last Name:BALAREZO
Suffix:
Gender:F
Credentials:MA MENTAL HEALTH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 TOMLINSON PL
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-3062
Mailing Address - Country:US
Mailing Address - Phone:203-543-0142
Mailing Address - Fax:
Practice Address - Street 1:100 TOMLINSON PL
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-3062
Practice Address - Country:US
Practice Address - Phone:203-543-0142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-11
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health