Provider Demographics
NPI:1477690337
Name:BOLADO, LARRY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:
Last Name:BOLADO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:LAURO
Other - Middle Name:
Other - Last Name:BOLADO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCUSW
Mailing Address - Street 1:1106 CLAYTON LN
Mailing Address - Street 2:242W
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723
Mailing Address - Country:US
Mailing Address - Phone:512-467-8486
Mailing Address - Fax:
Practice Address - Street 1:1106 CLAYTON LN
Practice Address - Street 2:242W
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723
Practice Address - Country:US
Practice Address - Phone:512-467-8486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX93581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical