Provider Demographics
NPI:1417256744
Name:CARR, PHILLIP (LICSW)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:CARR
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 1:8400 5TH AVE NE UNIT 8
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-4163
Mailing Address - Country:US
Mailing Address - Phone:206-954-3348
Mailing Address - Fax:206-566-6913
Practice Address - Street 1:8400 5TH AVE NE UNIT 8
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-4163
Practice Address - Country:US
Practice Address - Phone:206-954-3348
Practice Address - Fax:206-566-6913
Is Sole Proprietor?:No
Enumeration Date:2011-03-25
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW604947151041C0700X
WASC60189451104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker