Susan Balaban

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

048-0110612 Issued in VT

Practice address

1 Anna Marsh Lane
Brattleboro, VT 05302-0101

Phone

(802) 257-7785

Fax

(802) 258-3723

NPI assigned

Jan 14, 2016

Last updated

Jan 14, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VT, MA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Clinical Psychologist

Education

University of Massachusetts Medical School, 2013

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Brattleboro Retreat

  • Psychiatric Hospital
  • Brattleboro, VT
  • NPI 1730185232
  Medicare reassignment NPD
• Brattleboro Retreat

  dba Retreat Healthcare

  • Institutional Pharmacy
  • Brattleboro, VT
  • NPI 1295947950
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1452729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452729600000",
    "number": "1447616834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 ANNA MARSH LANE",
            "city": "BRATTLEBORO",
            "state": "VT",
            "postal_code": "053020101",
            "telephone_number": "802-257-7785",
            "fax_number": "802-258-3723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 ANNA MARSH LANE",
            "city": "BRATTLEBORO",
            "state": "VT",
            "postal_code": "053020101",
            "telephone_number": "802-257-7785",
            "fax_number": "802-258-3723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALABAN",
        "first_name": "SUSAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-01-14",
        "last_updated": "2016-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VT",
            "license": "048-0110612",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Audette, MS, CCC-A
• Aida Avdic, MD
• Awr Associates, LLC
• John Baker
• Katherine Jane Baker, APRN
• Kristen Mary Bald
• Percy Ballantine, MD
• Sarah Joy Ballou, MA
• Heather L Baribault, PNP
• Lydia M Barnes, MA LCMHC

• Clinical Psychologist in Brattleboro, VT
• Providers in Brattleboro, VT by specialty
• Clinical Psychologist in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.