Individual provider Active NPI

Stacey Elise Balkanski, LCSW

  • Clinical Social Worker
  • Plantation, FL
National Provider Identifier
1396079372
Registry record updated May 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
SW6977 Issued in FL
Practice address
817 South University Drive
Suite 121
Plantation, FL 33324
Phone
(754) 702-7659
Fax
(954) 200-6144
NPI assigned
Sep 24, 2009
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 20, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X SW6977 FL Primary

Addresses

Primary practice location

817 South University Drive
Suite 121
Plantation, FL 33324

Mailing address

9715 West Broward Boulevard
Box 230
Plantation, FL 33324
Phone (754) 702-7659

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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

Enrollment IDStateProvider typePAC IDDetails
I20110209000495 FL Practitioner - Clinical Social Worker 5092904185 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

817 S University Dr
Suite 121
Plantation, FL 33324-3318
Phone (754) 702-7659

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Stacey Balkanski, LCSW, LLC Clinical CurrentSince Jul 11, 2010 Accepting new patients

Locations

9715 W Broward Blvd
Plantation, FL 33324
Phone (954) 741-1099

817 S University Dr
Ste 121
Plantation, FL 33324
Phone (754) 702-7659

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1253750400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558310400000",
    "number": "1396079372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9715 WEST BROWARD BOULEVARD",
            "address_2": "BOX 230",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "33324",
            "telephone_number": "754-702-7659",
            "fax_number": "954-200-6144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "817 SOUTH UNIVERSITY DRIVE",
            "address_2": "SUITE 121",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "33324",
            "telephone_number": "754-702-7659",
            "fax_number": "954-200-6144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALKANSKI",
        "first_name": "STACEY",
        "middle_name": "ELISE",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-09-24",
        "last_updated": "2019-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW6977",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plantation, FL

Sources for this page

Verify at the official NPI Registry.