Provider Demographics
NPI:1386416154
Name:BALDERELLI, LEILA
Entity type:Individual
Prefix:
First Name:LEILA
Middle Name:
Last Name:BALDERELLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49B MONSON RD
Mailing Address - Street 2:
Mailing Address - City:WALES
Mailing Address - State:MA
Mailing Address - Zip Code:01081-9743
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:49B MONSON RD
Practice Address - Street 2:
Practice Address - City:WALES
Practice Address - State:MA
Practice Address - Zip Code:01081-9743
Practice Address - Country:US
Practice Address - Phone:413-250-9766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical