| Doctor Name: | MR. C HENRY BALDERRAMA |
| NPI Number: | 1003205147 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MSW, LICSW |
| License Number: | LW00005964 |
| Business Practice Address: | 1201 S Proctor St Tacoma, WA - 984052047 |
| Business Phone Number: | 2533965263 |
| Business Fax Number: | |
| Mailing Address: | 1102 Sw 348th Pl, FEDERAL WAY |
| State: | WA |
| Postal Code: | 980237029 |
| Phone Number: | 2065795382 |
| Fax Number: | |
| NPI Enumeration Date: | 01/13/2015 |
| NPI Last Update Date: | 09/10/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | LW00005964 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |