Provider Demographics
NPI:1639294770
Name:BALLIN, DANIEL MARK (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:MARK
Last Name:BALLIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 N WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5615
Mailing Address - Country:US
Mailing Address - Phone:323-461-3131
Mailing Address - Fax:323-957-7419
Practice Address - Street 1:1325 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5615
Practice Address - Country:US
Practice Address - Phone:323-461-3131
Practice Address - Fax:323-957-7419
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS192771041C0700X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical