Provider Demographics
NPI:1437326220
Name:KIERNAN, BRIAN A (LICSW)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:A
Last Name:KIERNAN
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:BRIAN
Other - Middle Name:E
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 84026
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-8426
Mailing Address - Country:US
Mailing Address - Phone:206-320-2484
Mailing Address - Fax:206-320-4568
Practice Address - Street 1:550 16TH AVE
Practice Address - Street 2:STE 100
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5699
Practice Address - Country:US
Practice Address - Phone:206-320-2484
Practice Address - Fax:206-320-4568
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW600999971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical