Provider Demographics
NPI:1780993642
Name:BALZOTTI, MARIEL MICHELLE (LISW, MSW)
Entity type:Individual
Prefix:
First Name:MARIEL
Middle Name:MICHELLE
Last Name:BALZOTTI
Suffix:
Gender:F
Credentials:LISW, MSW
Other - Prefix:
Other - First Name:MARIEL
Other - Middle Name:MICHELLE
Other - Last Name:DELLA-PIANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, MSW
Mailing Address - Street 1:1190 N 900 E
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3536
Mailing Address - Country:US
Mailing Address - Phone:801-631-4109
Mailing Address - Fax:
Practice Address - Street 1:1190 N 900 E
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3536
Practice Address - Country:US
Practice Address - Phone:801-631-4109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-27
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0076491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical