Provider Demographics
NPI:1003334160
Name:CLARK, TRINESE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:TRINESE
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:TRINESE
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1500 36TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-4009
Mailing Address - Country:US
Mailing Address - Phone:425-894-9715
Mailing Address - Fax:
Practice Address - Street 1:615 W TITUS ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-5749
Practice Address - Country:US
Practice Address - Phone:206-369-9766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-08
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW60312254104100000X
CA1185931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker