Provider Demographics
NPI:1902519861
Name:CREATING BALANCE, LCSW, P.C.
Entity Type:Organization
Organization Name:CREATING BALANCE, LCSW, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDECARR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:845-204-8092
Mailing Address - Street 1:4 MARSHALL RD
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-4105
Mailing Address - Country:US
Mailing Address - Phone:845-204-8092
Mailing Address - Fax:
Practice Address - Street 1:4 MARSHALL RD
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-4105
Practice Address - Country:US
Practice Address - Phone:845-204-8092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty