Provider Demographics
NPI:1558387514
Name:BALCERZAK, KATHLEEN (LISW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:BALCERZAK
Suffix:
Gender:F
Credentials:LISW
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 660
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44061-0660
Mailing Address - Country:US
Mailing Address - Phone:440-854-0217
Mailing Address - Fax:440-516-3783
Practice Address - Street 1:800 WOODBRIDGE TRL
Practice Address - Street 2:
Practice Address - City:SAGAMORE HILLS
Practice Address - State:OH
Practice Address - Zip Code:44067-2591
Practice Address - Country:US
Practice Address - Phone:216-662-7222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.00007741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH350225OtherWELLCARE HEALTH PLAN
OH7473139OtherAETNA
OH000000216083OtherANTHEM BLUE CROSS
OHT00774OtherSUMMACARE HEALTH PLAN
OH000000213561OtherANTHEM BLUE CROSS PIN
OH000000216083OtherUNICARE
OH000000216083OtherUNICARE
OH350225OtherWELLCARE HEALTH PLAN
OH000000213561OtherANTHEM BLUE CROSS PIN