Provider Demographics
NPI:1003205147
Name:BALDERRAMA, C HENRY (MSW, LICSW)
Entity Type:Individual
Prefix:MR
First Name:C
Middle Name:HENRY
Last Name:BALDERRAMA
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:HANK
Other - Middle Name:
Other - Last Name:BALDERRAMA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1102 SW 348TH PL
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-7029
Mailing Address - Country:US
Mailing Address - Phone:206-579-5382
Mailing Address - Fax:
Practice Address - Street 1:1201 S PROCTOR ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2047
Practice Address - Country:US
Practice Address - Phone:253-396-5263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000059641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical