Provider Demographics
NPI:1568634921
Name:BALKIN, CARRIE MICHELLE (LICSW)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:MICHELLE
Last Name:BALKIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6315 COLONY WAY
Mailing Address - Street 2:#2B
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2235
Mailing Address - Country:US
Mailing Address - Phone:612-385-9610
Mailing Address - Fax:
Practice Address - Street 1:6315 COLONY WAY
Practice Address - Street 2:#2B
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2235
Practice Address - Country:US
Practice Address - Phone:612-385-9610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN148771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical