Provider Demographics
NPI:1225027139
Name:BALIUS, FREDRICK A JR (MSW, LCSW-C)
Entity Type:Individual
Prefix:
First Name:FREDRICK
Middle Name:A
Last Name:BALIUS
Suffix:JR
Gender:M
Credentials:MSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 MONTEVUE LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-8214
Mailing Address - Country:US
Mailing Address - Phone:301-694-1029
Mailing Address - Fax:301-631-3111
Practice Address - Street 1:350 MONTEVUE LN
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-8214
Practice Address - Country:US
Practice Address - Phone:301-694-1029
Practice Address - Fax:301-631-3111
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-14
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD024501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDVA068235Medicare ID - Type Unspecified