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General NPI Number Information
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NPI Number | 1447498282
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Entity Type | Individual
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Provider Name | SUSAN A. BALIS MSS
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Gender | Female
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Dates
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Enumeration Date | 02/02/2009
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Last Update Date | 02/02/2009
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Provider Practice Location Address
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Address Line | 2542 BROWN ST
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City | PHILADELPHIA
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State | PA
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Zip | 19130-1811
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Country | US
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Telephone | 215-236-6300
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Fax |
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Provider Business Mailing Address
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Address Line | 2001 HAMILTON ST UNIT 1402
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City | PHILADELPHIA
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State | PA
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Zip | 19130-4201
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Country | US
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Telephone | 215-665-9977
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW012859
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License Number State | PA
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