Provider Demographics
NPI:1083827398
Name:BALZANO, CHRISTINE (CASAC-T)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:BALZANO
Suffix:
Gender:F
Credentials:CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 KANE AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4927
Mailing Address - Country:US
Mailing Address - Phone:631-803-0815
Mailing Address - Fax:
Practice Address - Street 1:55 HORIZON DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-4436
Practice Address - Country:US
Practice Address - Phone:631-920-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY19754-T101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)