Provider Demographics
NPI:1962179689
Name:BALANCED LIVING PSYCHOLOGICAL SOLUTIONS
Entity type:Organization
Organization Name:BALANCED LIVING PSYCHOLOGICAL SOLUTIONS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:SERRAVALLE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LPCMH, NCC
Authorized Official - Phone:302-824-3722
Mailing Address - Street 1:5879 SUMMIT BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:TOWNSEND
Mailing Address - State:DE
Mailing Address - Zip Code:19734-9375
Mailing Address - Country:US
Mailing Address - Phone:302-608-3780
Mailing Address - Fax:302-355-3226
Practice Address - Street 1:5879 SUMMIT BRIDGE RD
Practice Address - Street 2:
Practice Address - City:TOWNSEND
Practice Address - State:DE
Practice Address - Zip Code:19734-9375
Practice Address - Country:US
Practice Address - Phone:302-608-3780
Practice Address - Fax:302-355-3226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-30
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE250741282Medicaid
DEPC-0000607OtherLICENSED PROFESSIONAL COUNSELOR OF MENTAL HEALTH
DEB1-0011250OtherLICENSED PSYCHOLOGIST