Provider Demographics
NPI:1053295634
Name:BOADO BILTZ, TRIA PEARL PAIRES (LCSW, PPSC)
Entity type:Individual
Prefix:
First Name:TRIA PEARL
Middle Name:PAIRES
Last Name:BOADO BILTZ
Suffix:
Gender:F
Credentials:LCSW, PPSC
Other - Prefix:
Other - First Name:TRIA
Other - Middle Name:
Other - Last Name:BOADO BILTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW, PPSC
Mailing Address - Street 1:6299 N MARKS AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-1651
Mailing Address - Country:US
Mailing Address - Phone:559-824-9121
Mailing Address - Fax:
Practice Address - Street 1:6299 N MARKS AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-1651
Practice Address - Country:US
Practice Address - Phone:559-824-9121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1132971041S0200X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool