Healthcare Provider Details

I. General information

NPI: 1780841916
Provider Name (Legal Business Name): JEAN A. BALL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 ROXBURY RD
SCARSDALE NY
10583-2752
US

IV. Provider business mailing address

15 ROXBURY RD
SCARSDALE NY
10583-2752
US

V. Phone/Fax

Practice location:
  • Phone: 914-472-7617
  • Fax:
Mailing address:
  • Phone: 914-472-7617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR051485-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: