Samuel Edward Balla, LISW-S
Individual provider Active NPI Clinical Social Worker · Delaware, OH
NPI 1851744403 · NPPES record last updated Jul 19, 2016
Key facts
- NPI
- 1851744403
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- I1500113SUPV (OH)
- Practice address
- 88 N. Sandusky St
Delaware, OH 43015 - Phone
- (740) 203-3800
- Fax
- (740) 203-3799
- NPI assigned
- Jul 19, 2016
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170522002274 | OH | Practitioner - Clinical Social Worker | 2365719424 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| I1500113SUPV | OH | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sondermind Provider Network LLC | Clinical | Current |
Accepting new patients |
| Wellqor Psychological Services, PC | Clinical | Current |
Accepting new patients |
| Wellqor Psychological Services of California, PC | Clinical | Current |
Accepting new patients |
| Maryhaven Inc | Past | Accepting new patients |
Locations
135 Pinelawn Rd
Ste 204N
Melville, NY 11747
Phone (631) 328-2440
20 S 3rd St
Ste 210
Columbus, OH 43215
Phone (614) 208-4973
5232 Broadview Rd
Richfield, OH 44286
Phone (330) 623-6680
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | I1500113SUPV | OH | Yes |
Addresses
Primary practice location
88 N. Sandusky St
Delaware, OH 43015
Mailing address
1791 Alum Creek Dr
Columbus, OH 43207-1708
Phone (614) 445-8131
Other providers in Delaware, OH
- Backcare Chiropractic LLC
- Backcare Family Chiropractic, LLC
- Danielle Baker
- Susan Paige Baker
- Sylwia Bal
- Courtney Amanda Rene' Bargar
- Bruce Barker
- Gwynn Susan Barnes
- Jessica M Barnett
- Jessica Marie Barry
All providers in Delaware, OH · Clinical Social Worker in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 19, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.