Provider Demographics
NPI:1225875909
Name:BALUCH, ALIZAY
Entity type:Individual
Prefix:
First Name:ALIZAY
Middle Name:
Last Name:BALUCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 W 121ST ST APT 701
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-5931
Mailing Address - Country:US
Mailing Address - Phone:646-403-0533
Mailing Address - Fax:
Practice Address - Street 1:41 FLATBUSH AVE STE 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-1145
Practice Address - Country:US
Practice Address - Phone:646-762-0707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health