Provider Demographics
NPI:1801079009
Name:BOLDEN, MARQUITA JANINNE (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:MARQUITA
Middle Name:JANINNE
Last Name:BOLDEN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:MARQUITA
Other - Middle Name:JANINNE
Other - Last Name:EARL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8302 OLD YORK RD STE B1
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1529
Mailing Address - Country:US
Mailing Address - Phone:267-227-0122
Mailing Address - Fax:
Practice Address - Street 1:8302 OLD YORK RD STE B1
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1529
Practice Address - Country:US
Practice Address - Phone:267-227-0122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0169201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical