Healthcare Provider Details

I. General information

NPI: 1225319825
Provider Name (Legal Business Name): ESTELA BALLARD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2011
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 CABRILLO HWY S STE 200A
HALF MOON BAY CA
94019-7210
US

IV. Provider business mailing address

5501 STOCKDALE HWY PO BOX 9482
BAKERSFIELD CA
93309-2572
US

V. Phone/Fax

Practice location:
  • Phone: 650-726-6369
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW68510
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: