Provider Demographics
NPI:1083834451
Name:CRYAN, LAURA JEANNE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:JEANNE
Last Name:CRYAN
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 1:1904 3RD AVE
Mailing Address - Street 2:SUITE 630
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1126
Mailing Address - Country:US
Mailing Address - Phone:206-579-1592
Mailing Address - Fax:
Practice Address - Street 1:1904 3RD AVE
Practice Address - Street 2:SUITE 630
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1126
Practice Address - Country:US
Practice Address - Phone:206-579-1592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000049751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical