Provider Demographics
NPI:1740841949
Name:BOLEN-RAMOS, ALISSA MEGAN (ASW)
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:MEGAN
Last Name:BOLEN-RAMOS
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 BAUCHET ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-2985
Mailing Address - Country:US
Mailing Address - Phone:626-840-3470
Mailing Address - Fax:
Practice Address - Street 1:429 BAUCHET ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-2985
Practice Address - Country:US
Practice Address - Phone:626-840-3470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-27
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1222631041C0700X
CAACSW97148101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty