Jaime Samantha Balis, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

086530-01 Issued in NY

Practice address

82 Bounty LN
Jericho, NY 11753-2210

Phone

(516) 312-5739

NPI assigned

Aug 10, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1407628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651017600000",
    "number": "1235548793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 E 63RD ST APT 32G",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100657432",
            "telephone_number": "516-312-5739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "82 BOUNTY LN",
            "city": "JERICHO",
            "state": "NY",
            "postal_code": "117532210",
            "telephone_number": "516-312-5739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALIS",
        "first_name": "JAIME",
        "middle_name": "SAMANTHA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-08-10",
        "last_updated": "2022-04-27",
        "certification_date": "2022-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "086530-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elissa L. Ash, M.D.
• Audiology Services Company USA, LLC
• Rubina Azam, PHARM.D.
• Smita Krishna Badhey, MD
• Sakshi Bajaj, MD
• Susan Renee Banco, LCSW
• Sarika Banker, MD
• Debbie Barnes Leslie
• Renee Elaine Barnett, MS
• Brianna Barron

• Clinical Social Worker in Jericho, NY
• Providers in Jericho, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.