Provider Demographics
NPI:1295910503
Name:BALKAN, ELLEN MARGARET (LCSW)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARGARET
Last Name:BALKAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 N PALM DR APT 1C
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4105
Mailing Address - Country:US
Mailing Address - Phone:310-274-4876
Mailing Address - Fax:310-274-4485
Practice Address - Street 1:9730 WILSHIRE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-2003
Practice Address - Country:US
Practice Address - Phone:310-274-4876
Practice Address - Fax:310-274-4485
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS137141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical