Provider Demographics
NPI:1699928960
Name:CEBALLOS, ALBA LUZ (LMSW)
Entity type:Individual
Prefix:MS
First Name:ALBA
Middle Name:LUZ
Last Name:CEBALLOS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 PACKARD ST
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-4922
Mailing Address - Country:US
Mailing Address - Phone:201-436-4569
Mailing Address - Fax:201-436-4569
Practice Address - Street 1:100 DEBS PL APT 23F
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-2504
Practice Address - Country:US
Practice Address - Phone:917-214-4632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066903-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical