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General NPI Number Information
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NPI Number | 1003205147
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Entity Type | Individual
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Provider Name | C HENRY BALDERRAMA MSW, LICSW
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Gender | Male
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Dates
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Enumeration Date | 01/13/2015
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Last Update Date | 09/10/2015
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Provider Practice Location Address
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Address Line | 1201 S PROCTOR ST
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City | TACOMA
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State | WA
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Zip | 98405-2047
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Country | US
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Telephone | 253-396-5263
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Fax |
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Provider Business Mailing Address
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Address Line | 1102 SW 348TH PL
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City | FEDERAL WAY
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State | WA
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Zip | 98023-7029
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Country | US
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Telephone | 206-579-5382
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LW00005964
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License Number State | WA
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