Provider Demographics
NPI:1285819433
Name:AGNE, MARIA (LICSW, MSW, MA)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:AGNE
Suffix:
Gender:F
Credentials:LICSW, MSW, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 MARTIN LUTHER KING JR WAY S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-3112
Mailing Address - Country:US
Mailing Address - Phone:206-778-4735
Mailing Address - Fax:
Practice Address - Street 1:1100 19TH AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-3505
Practice Address - Country:US
Practice Address - Phone:206-778-4735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW00009338101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health