Provider Demographics
NPI:1871806505
Name:BALICK, ALYSSA LOUISE (LCSW)
Entity type:Individual
Prefix:MS
First Name:ALYSSA
Middle Name:LOUISE
Last Name:BALICK
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 1:12794 W FOREST HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-4710
Mailing Address - Country:US
Mailing Address - Phone:561-795-1518
Mailing Address - Fax:
Practice Address - Street 1:781 VILLA PORTOFINO CIR
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-8061
Practice Address - Country:US
Practice Address - Phone:561-313-2723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW91721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical