Provider Demographics
NPI:1295038123
Name:STACEY BALKANSKI, LCSW, LLC
Entity Type:Organization
Organization Name:STACEY BALKANSKI, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:ELISE
Authorized Official - Last Name:BALKANSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:954-557-8625
Mailing Address - Street 1:9715 W BROWARD BLVD # 230
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2351
Mailing Address - Country:US
Mailing Address - Phone:954-557-8625
Mailing Address - Fax:954-200-6144
Practice Address - Street 1:817 S UNIVERSITY DR STE 121
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3318
Practice Address - Country:US
Practice Address - Phone:754-702-7659
Practice Address - Fax:954-200-6144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-15
Last Update Date:2020-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty