Provider Demographics
NPI:1487935771
Name:BALIS, RYAN
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:BALIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 BART RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-1108
Mailing Address - Country:US
Mailing Address - Phone:203-275-6468
Mailing Address - Fax:
Practice Address - Street 1:107 BART RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-1108
Practice Address - Country:US
Practice Address - Phone:203-275-6468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical