Provider Demographics
NPI:1104076991
Name:BODAN, FRANCISCO J (LCSW)
Entity type:Individual
Prefix:
First Name:FRANCISCO
Middle Name:J
Last Name:BODAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:FRANCISCO
Other - Middle Name:J
Other - Last Name:ROBLES BODAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FRANCISCO ROBLES
Mailing Address - Street 1:PO BOX 242
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90714-0242
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21081 S WESTERN AVE
Practice Address - Street 2:SUITE 295
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-1707
Practice Address - Country:US
Practice Address - Phone:310-533-6600
Practice Address - Fax:310-787-9035
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA948311041C0700X
CA31375104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker