Provider Demographics
NPI:1215202866
Name:GERHARDSTEIN, JEFFREY J (LICSW)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:J
Last Name:GERHARDSTEIN
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 1:714 HARVARD AVE E
Mailing Address - Street 2:301
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-4641
Mailing Address - Country:US
Mailing Address - Phone:206-709-4490
Mailing Address - Fax:
Practice Address - Street 1:502 RAINIER AVE S
Practice Address - Street 2:204
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-2085
Practice Address - Country:US
Practice Address - Phone:206-678-7060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW 000093211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical