Provider Demographics
NPI:1053480715
Name:BIRD, DAVID JAMES (LICSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JAMES
Last Name:BIRD
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 1:130 NICKERSON ST
Mailing Address - Street 2:#201
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-1658
Mailing Address - Country:US
Mailing Address - Phone:206-284-5152
Mailing Address - Fax:206-284-5152
Practice Address - Street 1:130 NICKERSON ST
Practice Address - Street 2:#201
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-1658
Practice Address - Country:US
Practice Address - Phone:206-284-5152
Practice Address - Fax:206-284-5152
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000050161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical