Provider Demographics
NPI:1861450249
Name:BALLARD, MARGARET LEE (RN LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:LEE
Last Name:BALLARD
Suffix:
Gender:F
Credentials:RN LCSW
Other - Prefix:MRS
Other - First Name:LEE
Other - Middle Name:FOX
Other - Last Name:BALLARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN LCSW
Mailing Address - Street 1:4690 HOLLY DRIVE
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418
Mailing Address - Country:US
Mailing Address - Phone:561-622-9431
Mailing Address - Fax:561-622-9431
Practice Address - Street 1:600 SANDTREE DR
Practice Address - Street 2:SUITE 202A
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33403-1597
Practice Address - Country:US
Practice Address - Phone:561-845-6722
Practice Address - Fax:561-622-9431
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN1602062163W00000X
FLSW53541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ9521OtherBLUE CROSS BLUE SHIELD