Provider Demographics
NPI:1750412045
Name:BALLESTEROS, MARIA ELENA (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:ELENA
Last Name:BALLESTEROS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:300 ALBANY ST
Mailing Address - Street 2:3C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10280-1404
Mailing Address - Country:US
Mailing Address - Phone:212-227-9081
Mailing Address - Fax:212-927-6089
Practice Address - Street 1:3940 BROADWAY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1543
Practice Address - Country:US
Practice Address - Phone:212-781-5500
Practice Address - Fax:212-927-6089
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPO63862-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical