| Doctor Name: | BRUCE P. BALTER |
| NPI Number: | 1285723155 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LICSW |
| License Number: | 1018796 |
| Business Practice Address: | 322 State Road. Vineyard Haven, MA - 02568 |
| Business Phone Number: | 5086967643 |
| Business Fax Number: | 5086933036 |
| Mailing Address: | 64 Winemack Ave., Po Box 106 OAK BLUFFS |
| State: | MA |
| Postal Code: | 02557 |
| Phone Number: | 5086967643 |
| Fax Number: | 5086933036 |
| NPI Enumeration Date: | 10/11/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 1018796 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |