Provider Demographics
NPI:1356724421
Name:BALIVA, DANIELLE (MSW)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:
Last Name:BALIVA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MRS
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:BALIVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:75 BRIGHTON AVE
Mailing Address - Street 2:APT 6
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-2110
Mailing Address - Country:US
Mailing Address - Phone:585-613-5024
Mailing Address - Fax:
Practice Address - Street 1:75 BRIGHTON AVE
Practice Address - Street 2:APT 6
Practice Address - City:ALLSTON
Practice Address - State:MA
Practice Address - Zip Code:02134-2110
Practice Address - Country:US
Practice Address - Phone:585-613-5024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1225251041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical