MEDICARE: BALANCE BREATH LCSW PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1366385767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALANCE BREATH LCSW PLLC

Provider Business Mailing Address
First Line	:	167 BROADWAY STE 204
Second Line	:
City	:	AMITYVILLE
State	:	NY
Zip	:	11701-2782
Country	:	US
Telephone Number	:	631-204-3257
Fax Number	:

Provider Business Practice Location Address
First Line	:	167 BROADWAY STE 204
Second Line	:
City	:	AMITYVILLE
State	:	NY
Zip	:	11701-2782
Country	:	US
Telephone Number	:	631-204-3257
Fax Number	:

Authorized Official
Title or Position	:	LCSW/OWNER
Name	:	JAMIE SVENSON
Credential	:	LCSW
Telephone Number	:	631-204-3257

Provider Enumeration Date	:	04/10/2026
Last Update Date	:	04/10/2026

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