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General NPI Number Information
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NPI Number | 1366960767
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Entity Type | Individual
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Provider Name | MICHAEL BALLES LCSW
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Gender | Male
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Dates
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Enumeration Date | 09/06/2017
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Last Update Date | 03/08/2023
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Provider Practice Location Address
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Address Line | 75 SEMINARY HILL RD
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City | CARMEL
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State | NY
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Zip | 10512-1921
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Country | US
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Telephone | 845-225-3400
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Fax | 845-704-6182
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Provider Business Mailing Address
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Address Line | 876 LATTINTOWN RD
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City | MILTON
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State | NY
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Zip | 12547-5232
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 101296
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 093530
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License Number State | NY
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