Provider Demographics
NPI:1093089625
Name:BALCAZAR, SERGIO JR (LMFT)
Entity Type:Individual
Prefix:MR
First Name:SERGIO
Middle Name:
Last Name:BALCAZAR
Suffix:JR
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 W CYPRESS CREEK RD
Mailing Address - Street 2:D104
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-1744
Mailing Address - Country:US
Mailing Address - Phone:954-514-7569
Mailing Address - Fax:
Practice Address - Street 1:2700 W CYPRESS CREEK RD
Practice Address - Street 2:D104
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-1744
Practice Address - Country:US
Practice Address - Phone:954-514-7569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2634106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist