Provider Demographics
NPI:1699878488
Name:BALICER, FELICIA MERRILL (LCSW R)
Entity type:Individual
Prefix:MS
First Name:FELICIA
Middle Name:MERRILL
Last Name:BALICER
Suffix:
Gender:F
Credentials:LCSW R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 HARRISON STREET
Mailing Address - Street 2:4E
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10013
Mailing Address - Country:US
Mailing Address - Phone:646-641-5206
Mailing Address - Fax:212-608-3848
Practice Address - Street 1:40 HARRISON STREET
Practice Address - Street 2:4E
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10013
Practice Address - Country:US
Practice Address - Phone:646-641-5206
Practice Address - Fax:212-608-3848
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO48815-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN1J993Medicare ID - Type Unspecified