Provider Demographics
NPI:1639684574
Name:BALLARD, AMRITA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:AMRITA
Middle Name:
Last Name:BALLARD
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 1:21881 98TH AVE
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11429-1379
Mailing Address - Country:US
Mailing Address - Phone:347-729-8232
Mailing Address - Fax:
Practice Address - Street 1:21881 98TH AVE
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11429-1379
Practice Address - Country:US
Practice Address - Phone:347-729-8232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-13
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101651-1104100000X
NY101651-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty