Provider Demographics
NPI:1033688221
Name:PADUA, MARIBEL (PHD)
Entity Type:Individual
Prefix:
First Name:MARIBEL
Middle Name:
Last Name:PADUA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23515 NE NOVELTY HILL RD.
Mailing Address - Street 2:STE. B221, #158
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98053
Mailing Address - Country:US
Mailing Address - Phone:206-762-1010
Mailing Address - Fax:
Practice Address - Street 1:1660 S COLUMBIAN WAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-1532
Practice Address - Country:US
Practice Address - Phone:206-762-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-1728103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist