Provider Demographics
NPI:1669662847
Name:BOLDRICK, ELEANOR THOMSON (LCSW)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:THOMSON
Last Name:BOLDRICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3270 KERNER BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-4840
Mailing Address - Country:US
Mailing Address - Phone:415-473-6806
Mailing Address - Fax:415-473-6313
Practice Address - Street 1:3270 KERNER BLVD STE B
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-4840
Practice Address - Country:US
Practice Address - Phone:415-473-6806
Practice Address - Fax:415-473-6313
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000040771041C0700X
CALCS 264061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical