Provider Demographics
NPI:1164237335
Name:BALMASEDA, ELENA MARIE
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:MARIE
Last Name:BALMASEDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 EDWARD ST
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-2155
Mailing Address - Country:US
Mailing Address - Phone:847-797-2689
Mailing Address - Fax:
Practice Address - Street 1:240 EDWARD ST
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-2155
Practice Address - Country:US
Practice Address - Phone:847-797-2689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208001240106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist