Provider Demographics
NPI:1770217242
Name:BALTAZAR, DESIREE (LMSW)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:BALTAZAR
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 1:2110 HIGDON FERRY RD STE D
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-7288
Mailing Address - Country:US
Mailing Address - Phone:501-262-2766
Mailing Address - Fax:501-262-2544
Practice Address - Street 1:2110 HIGDON FERRY RD STE D
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-7288
Practice Address - Country:US
Practice Address - Phone:501-262-2766
Practice Address - Fax:501-262-2544
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR12109-M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker