Provider Demographics
NPI:1194360370
Name:MANZI-SAKUMA, JOANNA (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:
Last Name:MANZI-SAKUMA
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 1:432 NE RAVENNA BLVD APT 302
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-8448
Mailing Address - Country:US
Mailing Address - Phone:206-251-8391
Mailing Address - Fax:
Practice Address - Street 1:600 N 36TH ST STE 320
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8698
Practice Address - Country:US
Practice Address - Phone:206-251-8391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-12
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW610315391041C0700X
WALW00008220104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker