Provider Demographics
NPI:1043466824
Name:SMITH, CARRIE LYNNE (LICSW)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:LYNNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2033 MINOR AVE E
Mailing Address - Street 2:#6
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3574
Mailing Address - Country:US
Mailing Address - Phone:206-329-4763
Mailing Address - Fax:
Practice Address - Street 1:2033 MINOR AVE E
Practice Address - Street 2:#6
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3574
Practice Address - Country:US
Practice Address - Phone:206-329-4763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000041871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical