Provider Demographics
NPI:1245901040
Name:ECLECTIC BALANCE LLC
Entity type:Organization
Organization Name:ECLECTIC BALANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-477-8751
Mailing Address - Street 1:1200 HIGH RIDGE RD
Mailing Address - Street 2:HUMANLY SUITE
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-2112
Mailing Address - Country:US
Mailing Address - Phone:201-477-8751
Mailing Address - Fax:
Practice Address - Street 1:75 S BROADWAY
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4413
Practice Address - Country:US
Practice Address - Phone:201-477-8751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-22
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty