Provider Demographics
NPI:1396079372
Name:BALKANSKI, STACEY ELISE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:ELISE
Last Name:BALKANSKI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9715 WEST BROWARD BOULEVARD
Mailing Address - Street 2:BOX 230
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324
Mailing Address - Country:US
Mailing Address - Phone:754-702-7659
Mailing Address - Fax:954-200-6144
Practice Address - Street 1:817 SOUTH UNIVERSITY DRIVE
Practice Address - Street 2:SUITE 121
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324
Practice Address - Country:US
Practice Address - Phone:754-702-7659
Practice Address - Fax:954-200-6144
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW69771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical