Provider Demographics
NPI:1982702981
Name:BOONE, ERIC FRANCIS (LICSW)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:FRANCIS
Last Name:BOONE
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3023 LYNN AVE
Mailing Address - Street 2:APT 25
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4040
Mailing Address - Country:US
Mailing Address - Phone:612-454-9798
Mailing Address - Fax:
Practice Address - Street 1:314 CLIFTON AVE STE 200C
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3226
Practice Address - Country:US
Practice Address - Phone:612-454-9798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10413101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN460673600Medicaid