Provider Demographics
NPI:1093431702
Name:BALZER, ELIZABETH P (LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:P
Last Name:BALZER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:900 WALT WHITMAN RD STE LL1
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2215
Mailing Address - Country:US
Mailing Address - Phone:516-698-5511
Mailing Address - Fax:516-418-5377
Practice Address - Street 1:900 WALT WHITMAN RD STE LL1
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-2215
Practice Address - Country:US
Practice Address - Phone:516-698-5511
Practice Address - Fax:516-418-5377
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0711051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical