Healthcare Provider Details

I. General information

NPI: 1780993642
Provider Name (Legal Business Name): MARIEL MICHELLE BALZOTTI LISW, MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIEL MICHELLE DELLA-PIANA LCSW, MSW

II. Dates (important events)

Enumeration Date: 09/27/2010
Last Update Date: 05/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 N 900 E
PROVO UT
84604-3536
US

IV. Provider business mailing address

1190 N 900 E
PROVO UT
84604-3536
US

V. Phone/Fax

Practice location:
  • Phone: 801-631-4109
  • Fax:
Mailing address:
  • Phone: 801-631-4109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number007649
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: