Provider Demographics
NPI:1225527831
Name:BRAZZALE, ANDREW ROBERT (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:ROBERT
Last Name:BRAZZALE
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17330 135TH AVE NE STE 2B
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-8522
Mailing Address - Country:US
Mailing Address - Phone:773-934-5551
Mailing Address - Fax:844-837-1339
Practice Address - Street 1:17330 135TH AVE NE STE 2B
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-8522
Practice Address - Country:US
Practice Address - Phone:773-934-5551
Practice Address - Fax:844-837-1339
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149024969104100000X
WALW61056500104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker