Provider Demographics
NPI:1427307180
Name:BALITZ, MADELYN CATHERINE (LCSW,ACHP-SW)
Entity type:Individual
Prefix:MRS
First Name:MADELYN
Middle Name:CATHERINE
Last Name:BALITZ
Suffix:
Gender:F
Credentials:LCSW,ACHP-SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4249 CONGREVE PL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34241-6130
Mailing Address - Country:US
Mailing Address - Phone:941-504-0314
Mailing Address - Fax:
Practice Address - Street 1:5380 GULF OF MEXICO DR
Practice Address - Street 2:
Practice Address - City:LONGBOAT KEY
Practice Address - State:FL
Practice Address - Zip Code:34228-2048
Practice Address - Country:US
Practice Address - Phone:941-238-0266
Practice Address - Fax:941-244-5505
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW53821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical