Provider Demographics
NPI:1437605102
Name:KUBOTA, RENEE (MSW)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:KUBOTA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3040 78TH AVE SE #1714
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040
Mailing Address - Country:US
Mailing Address - Phone:415-619-6897
Mailing Address - Fax:
Practice Address - Street 1:4519 40TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3939
Practice Address - Country:US
Practice Address - Phone:720-278-1496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC607867741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical