Healthcare Provider Details

I. General information

NPI: 1366960767
Provider Name (Legal Business Name): MICHAEL BALLES LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 SEMINARY HILL RD
CARMEL NY
10512-1921
US

IV. Provider business mailing address

876 LATTINTOWN RD
MILTON NY
12547-5232
US

V. Phone/Fax

Practice location:
  • Phone: 845-225-3400
  • Fax: 845-704-6182
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number101296
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number093530
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: