Provider Demographics
NPI:1356382683
Name:BALLI, BERTA (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:BERTA
Middle Name:
Last Name:BALLI
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9600 VETERANS DR SW BLDG 4-243
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98493-0003
Mailing Address - Country:US
Mailing Address - Phone:253-583-3513
Mailing Address - Fax:
Practice Address - Street 1:9600 VETERANS DR SW BLDG 4-243
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98493-1874
Practice Address - Country:US
Practice Address - Phone:253-585-3513
Practice Address - Fax:541-971-9807
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00053006101YM0800X
ORL86651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health