Provider Demographics
NPI:1962746206
Name:BALLOU, CYNTHIA (PSYD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:
Last Name:BALLOU
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:GARVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:9 SUMMER ST UNIT 302
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038-1493
Mailing Address - Country:US
Mailing Address - Phone:781-713-0797
Mailing Address - Fax:781-205-1241
Practice Address - Street 1:9 SUMMER ST UNIT 302
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MA
Practice Address - Zip Code:02038-1493
Practice Address - Country:US
Practice Address - Phone:781-713-0797
Practice Address - Fax:781-205-1241
Is Sole Proprietor?:No
Enumeration Date:2012-11-26
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110026265Medicaid