Provider Demographics
NPI:1932891710
Name:BALANCE WITH INTENT PSYCHOLOGY, PLLC
Entity Type:Organization
Organization Name:BALANCE WITH INTENT PSYCHOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKLES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:718-390-8815
Mailing Address - Street 1:21905 74TH AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11364-3031
Mailing Address - Country:US
Mailing Address - Phone:516-318-0297
Mailing Address - Fax:
Practice Address - Street 1:166 BROADWAY STE 19
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2704
Practice Address - Country:US
Practice Address - Phone:718-390-8815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty