Provider Demographics
NPI:1124538103
Name:SONENTHAL, SETH R (LICSW, SUDP)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:R
Last Name:SONENTHAL
Suffix:
Gender:M
Credentials:LICSW, SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1155
Mailing Address - Country:US
Mailing Address - Phone:206-643-2026
Mailing Address - Fax:
Practice Address - Street 1:1902 2ND AVE STE 208
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1186
Practice Address - Country:US
Practice Address - Phone:206-643-2026
Practice Address - Fax:206-448-8495
Is Sole Proprietor?:No
Enumeration Date:2017-10-04
Last Update Date:2023-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60668618101YA0400X
WALW60951016104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)