Provider Demographics
NPI:1861537771
Name:BALSAVAGE, LAURIE ANN (LCSW)
Entity type:Individual
Prefix:MS
First Name:LAURIE ANN
Middle Name:
Last Name:BALSAVAGE
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 1:124 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SUNBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17801-2102
Mailing Address - Country:US
Mailing Address - Phone:570-988-0804
Mailing Address - Fax:
Practice Address - Street 1:124 N 2ND ST
Practice Address - Street 2:
Practice Address - City:SUNBURY
Practice Address - State:PA
Practice Address - Zip Code:17801-2102
Practice Address - Country:US
Practice Address - Phone:570-988-0804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW012388101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA786515Medicare ID - Type UnspecifiedOUTPATIENT MH COUNSELING