Provider Demographics
NPI:1124027537
Name:BALLAS-ROWE, TONI MARIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TONI
Middle Name:MARIE
Last Name:BALLAS-ROWE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 681
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-0681
Mailing Address - Country:US
Mailing Address - Phone:302-645-0633
Mailing Address - Fax:302-226-8681
Practice Address - Street 1:16529 COASTAL HWY UNIT 120
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-3697
Practice Address - Country:US
Practice Address - Phone:302-645-0633
Practice Address - Fax:302-226-8681
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ10000204101Y00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
R49674Medicare UPIN
DE131473Medicare ID - Type Unspecified