Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 0911 | OR |
N | 103T00000X | Psychologist | 0911 | OR |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 0911 | OR |
N | 103G00000X | Clinical Psychologist | 0911 | OR |
N | 103TC0700X | Clinical Psychologist | 0911 | OR |
N | 103TF0200X | Forensic Psychologist | 0911 | OR |
N | 103TP2701X | Group Psychotherapist | 0911 | OR |
NPI | 1225085194 |
---|---|
Provider Name | Dr. Joseph Anthony Balsamo |
First Address | Portland, OR 97209-2327 |
Second Address | Portland, OR 97209-2327 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
046966 | OREGON MEDICAL ASSISTANCE (01) | OR |