Provider Demographics
NPI:1396513453
Name:BASIN, DANIELLA
Entity type:Individual
Prefix:
First Name:DANIELLA
Middle Name:
Last Name:BASIN
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 1:11901 SANTA MONICA BLVD.
Mailing Address - Street 2:SUITE 110 PMB 336
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-4009
Mailing Address - Country:US
Mailing Address - Phone:310-439-8312
Mailing Address - Fax:
Practice Address - Street 1:11901 SANTA MONICA BLVD.
Practice Address - Street 2:SUITE 110 PMB 336
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5729
Practice Address - Country:US
Practice Address - Phone:310-439-8312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA147763106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist