Provider Demographics
NPI:1164519815
Name:BALBO, CRISTINA JOSEPHINE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CRISTINA
Middle Name:JOSEPHINE
Last Name:BALBO
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 1:46 MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2413
Mailing Address - Country:US
Mailing Address - Phone:631-423-4967
Mailing Address - Fax:
Practice Address - Street 1:46 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2413
Practice Address - Country:US
Practice Address - Phone:631-423-4967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053236 11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical