Provider Demographics
NPI:1497473540
Name:BALBO, CARRIE (LMSW)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:BALBO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 E GLACIER PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-2884
Mailing Address - Country:US
Mailing Address - Phone:602-487-2728
Mailing Address - Fax:
Practice Address - Street 1:1836 E GLACIER PL
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-2884
Practice Address - Country:US
Practice Address - Phone:602-487-2728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-20660104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker