Provider Demographics
NPI:1720411465
Name:BALOCCA, DANIELLE
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:BALOCCA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-5042
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:338 MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-5042
Practice Address - Country:US
Practice Address - Phone:781-246-2010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1303287OtherMBHP
MA1303287Medicaid
MA0000023532OtherBMC
MA1004745OtherNHP
MAM18633OtherBCBS
MA042611055OtherTAX ID
MA99618201OtherNETWORK HEALTH