Provider Demographics
NPI:1538818125
Name:BALTER, LAURI ANN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LAURI ANN
Middle Name:
Last Name:BALTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 YUMA LN
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-2636
Mailing Address - Country:US
Mailing Address - Phone:631-579-7033
Mailing Address - Fax:
Practice Address - Street 1:20 YUMA LN
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2636
Practice Address - Country:US
Practice Address - Phone:631-579-7033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY092957-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY092957-01OtherINSURANCE