NPIMap

Organization Active NPI

Blue Balloon LCSW PLLC

  • Clinical Social Worker
  • Kearny, NJ
National Provider Identifier
1043898224
Registry record updated Mar 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
BLUE BALLOON LCSW PLLC
Practice address
175 Belgrove Dr
Kearny, NJ 07032-1507
Phone
(201) 216-9500
NPI assigned
Mar 30, 2021
Last updated
Mar 30, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dovid Sussman
Title
Member
Phone
(201) 216-9500

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X NU Primary
Behavior Analyst 103K00000X NU

Addresses

Primary practice location

175 Belgrove Dr
Kearny, NJ 07032-1507

Mailing address

175 Belgrove Dr
Kearny, NJ 07032-1507

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1617062400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617062400000",
    "number": "1043898224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 BELGROVE DR",
            "city": "KEARNY",
            "state": "NJ",
            "postal_code": "070321507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 BELGROVE DR",
            "city": "KEARNY",
            "state": "NJ",
            "postal_code": "070321507",
            "telephone_number": "201-216-9500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE BALLOON LCSW PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-30",
        "last_updated": "2021-03-30",
        "certification_date": "2021-03-30",
        "status": "A",
        "authorized_official_last_name": "SUSSMAN",
        "authorized_official_first_name": "DOVID",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "201-216-9500"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kearny, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.