Provider Demographics
NPI:1134866429
Name:WELL BALANCED MEN PLLC
Entity type:Organization
Organization Name:WELL BALANCED MEN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MAXIM
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ARBUZOV
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:413-627-8271
Mailing Address - Street 1:24013 MADACA LN UNIT 202
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33954-2807
Mailing Address - Country:US
Mailing Address - Phone:413-627-8271
Mailing Address - Fax:
Practice Address - Street 1:24013 MADACA LN UNIT 202
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33954-2807
Practice Address - Country:US
Practice Address - Phone:413-627-8271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty