Most Relevant Information
Provider Data
| NPI Number: | 1003535832 |
| Provider Name: | DENA LOUISE BALO LAC |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: | 37AC00663100 |
Most Important Dates
| Enumeration Date: | 08/24/2022 |
| Last Updated: | 08/24/2022 |
Provider Practice Location
801 LACEY RD
FORKED RIVER
NJ
087311301
Practice Location Phone/Fax
| Phone: | 6099718989 |
| Fax: |
Provider Mailing Location
801 LACEY RD
FORKED RIVER
NJ
087311301
Provider Mailing Phone/Fax
| Phone: | 6099718989 |
| Fax: |