Provider Demographics
NPI:1417135146
Name:LATHROP-SKALOS, MARIA CAMPBELL (LCSW, LICSW, BCD)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:CAMPBELL
Last Name:LATHROP-SKALOS
Suffix:
Gender:F
Credentials:LCSW, LICSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15811 AMBAUM BLVD SW STE 110
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-3071
Mailing Address - Country:US
Mailing Address - Phone:206-242-8211
Mailing Address - Fax:206-242-0162
Practice Address - Street 1:15811 AMBAUM BLVD SW STE 110
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3071
Practice Address - Country:US
Practice Address - Phone:206-242-8211
Practice Address - Fax:206-242-0162
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID381311041C0700X
WA608704681041C0700X
LA32641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical