Provider Demographics
NPI:1336454859
Name:BALDESSARINI, JOHN W (MED)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:BALDESSARINI
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FREDERICK ABBOTT WAY
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-7992
Mailing Address - Country:US
Mailing Address - Phone:508-620-0010
Mailing Address - Fax:508-875-1439
Practice Address - Street 1:1 FREDERICK ABBOTT WAY
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-7992
Practice Address - Country:US
Practice Address - Phone:508-620-0010
Practice Address - Fax:508-875-1439
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS37647914101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health