Provider Demographics
NPI:1053525808
Name:BALANCE AND WELL BEING LLC
Entity type:Organization
Organization Name:BALANCE AND WELL BEING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LUCIA
Authorized Official - Last Name:MONTALBANO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, CASAC
Authorized Official - Phone:631-368-0354
Mailing Address - Street 1:514 LARKFIELD RD
Mailing Address - Street 2:SUITE 4A
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-4211
Mailing Address - Country:US
Mailing Address - Phone:631-368-0354
Mailing Address - Fax:
Practice Address - Street 1:514 LARKFIELD RD
Practice Address - Street 2:SUITE 4A
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-4211
Practice Address - Country:US
Practice Address - Phone:631-368-0354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003745101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty