Provider Demographics
NPI:1053883173
Name:BALESTIER, LOURDES T
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:T
Last Name:BALESTIER
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 1:1500 MAIN STREET
Mailing Address - Street 2:8TH FLOOR
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01115
Mailing Address - Country:US
Mailing Address - Phone:413-276-6086
Mailing Address - Fax:
Practice Address - Street 1:1500 MAIN STREET
Practice Address - Street 2:8TH FLOOR
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01115
Practice Address - Country:US
Practice Address - Phone:413-276-6086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-31
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor