Provider Demographics
NPI:1427823566
Name:BALLANTYNE-DURAND, GEORGIA N (MSW)
Entity type:Individual
Prefix:
First Name:GEORGIA
Middle Name:N
Last Name:BALLANTYNE-DURAND
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 669611
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33066-9611
Mailing Address - Country:US
Mailing Address - Phone:305-409-5920
Mailing Address - Fax:
Practice Address - Street 1:2701 W OAKLAND PARK BLVD STE 400A
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33311-1389
Practice Address - Country:US
Practice Address - Phone:305-409-5920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19246104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker