Doctor Name: | YEVGENI BALICEK |
NPI Number: | 1053702548 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | M-08056 |
Business Practice Address: | 2010 Industrial Park Rd Espanola, NM - 875323600 |
Business Phone Number: | 5057537395 |
Business Fax Number: | 5057538373 |
Mailing Address: | Po Box 158, El Centro Family Health ESPANOLA |
State: | NM |
Postal Code: | 875320158 |
Phone Number: | 5057537218 |
Fax Number: | 5057535815 |
NPI Enumeration Date: | 02/05/2015 |
NPI Last Update Date: | 02/05/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | M-08056 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |