Heather Diane Balzomo, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

L7178 Issued in OR

Practice address

675 N 5TH St
Lebanon, OR 97355-2875

Phone

(541) 451-6282

Fax

(541) 812-2038

NPI assigned

Oct 26, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1477440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604966400000",
    "number": "1598217408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1193",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973391193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 N 5TH ST",
            "city": "LEBANON",
            "state": "OR",
            "postal_code": "973552875",
            "telephone_number": "541-451-6282",
            "fax_number": "541-812-2038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALZOMO",
        "first_name": "HEATHER",
        "middle_name": "DIANE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-26",
        "last_updated": "2020-11-10",
        "certification_date": "2020-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L7178",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hbalzomo131906@samhealth.direct-ci.com",
            "affiliation": "N",
            "address_1": "675 N 5th St",
            "city": "Lebanon",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973552875",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Sharmeen Azad
• Carrie Lynn Babcock
• Elizabeth Westwood Baer, CPM, LDM
• John V. Bailey, M.D.
• Sydney Carol Baker
• Kelsey Baran
• William G. Barish, M.D.
• Daniel Ryan Barker, MSW
• Tasha Barkley, M. D. M.P.H.
• Winnie Barron, PA-C

• Clinical Social Worker in Lebanon, OR
• Providers in Lebanon, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2020; 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.