Provider Demographics
NPI:1427739119
Name:BALCOM, MARYCATHERINE
Entity type:Individual
Prefix:
First Name:MARYCATHERINE
Middle Name:
Last Name:BALCOM
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 1:4921 1ST ST NW APT 1
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-3355
Mailing Address - Country:US
Mailing Address - Phone:413-446-5969
Mailing Address - Fax:
Practice Address - Street 1:4921 1ST ST NW APT 1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-3355
Practice Address - Country:US
Practice Address - Phone:413-446-5969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG200002545104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker