Provider Demographics
NPI:1811057243
Name:PADILLA, BACILIO H (LICSW)
Entity type:Individual
Prefix:MR
First Name:BACILIO
Middle Name:H
Last Name:PADILLA
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:BACILIO
Other - Middle Name:HERNANDEZ
Other - Last Name:PADILLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:303 E D ST
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-2300
Mailing Address - Country:US
Mailing Address - Phone:509-853-1300
Mailing Address - Fax:509-966-3676
Practice Address - Street 1:303 E D ST
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-2300
Practice Address - Country:US
Practice Address - Phone:509-853-1300
Practice Address - Fax:509-966-3676
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW60282651104100000X
WARC00048290104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2304837Medicaid