Balanced Life Counseling LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

BALANCED LIFE COUNSELING LLC

Practice address

45 Fair St
Wallingford, CT 06492-4208

Phone

(860) 901-7916

NPI assigned

Nov 19, 2021

Last updated

Jul 3, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Samantha Nicole Forst, LCSW

Title

Social Worker

Phone

(860) 901-7916

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Samantha Lizotte, LCSW

  • Clinical Social Worker
  • Wallingford, CT
  • NPI 1073193116
  Medicare reassignment NPD

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

{
    "created_epoch": "1637280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688342400000",
    "number": "1619634177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2079 KILLINGLY CMNS # 1019",
            "city": "KILLINGLY",
            "state": "CT",
            "postal_code": "062412190",
            "telephone_number": "860-901-7916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 FAIR ST",
            "city": "WALLINGFORD",
            "state": "CT",
            "postal_code": "064924208",
            "telephone_number": "860-901-7916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BALANCED LIFE COUNSELING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-19",
        "last_updated": "2023-07-03",
        "certification_date": "2023-07-03",
        "status": "A",
        "authorized_official_last_name": "FORST",
        "authorized_official_first_name": "SAMANTHA",
        "authorized_official_middle_name": "NICOLE",
        "authorized_official_title_or_position": "SOCIAL WORKER",
        "authorized_official_telephone_number": "860-901-7916",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Alyssa Jeannette Axelrod, LCSW
• Alfredo Luis Axtmayer, MD
• Alexander Baaklini, DO
• Back on Course LLC
• Balanced Nutrition LLC
• Rebecca Balemian, RD CDN
• Lisa Marie Bankowski, RN
• Elizabeth E Barfield, OTR/L
• Doreen Gail Barile, RPH

• Clinical Social Worker in Wallingford, CT
• Providers in Wallingford, CT by specialty
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.