Provider Demographics
NPI:1366271462
Name:BORCHARDT, STEVEN (LICSW)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:BORCHARDT
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 1:3510 ULYSSES ST NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418-1446
Mailing Address - Country:US
Mailing Address - Phone:612-990-9506
Mailing Address - Fax:
Practice Address - Street 1:6 E DIAMOND LAKE RD
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55419-1923
Practice Address - Country:US
Practice Address - Phone:612-460-7145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN295631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical