Provider Demographics
NPI:1649852617
Name:BALLENILLA, ESPERANZA (LCSW-C)
Entity type:Individual
Prefix:
First Name:ESPERANZA
Middle Name:
Last Name:BALLENILLA
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7310 RITCHIE HWY
Mailing Address - Street 2:SUITE #200-GB37
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061
Mailing Address - Country:US
Mailing Address - Phone:253-886-7324
Mailing Address - Fax:410-744-0091
Practice Address - Street 1:325 HOSPITAL DR STE 106
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5806
Practice Address - Country:US
Practice Address - Phone:443-430-2998
Practice Address - Fax:443-431-8978
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD22719OtherLICENSE