Provider Demographics
NPI:1477784759
Name:DURAZO, ALEJANDRO (LW60282782)
Entity Type:Individual
Prefix:MR
First Name:ALEJANDRO
Middle Name:
Last Name:DURAZO
Suffix:
Gender:M
Credentials:LW60282782
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 S COLUMBIAN WAY
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-1532
Mailing Address - Country:US
Mailing Address - Phone:206-499-8623
Mailing Address - Fax:425-203-7217
Practice Address - Street 1:1660 S COLUMBIAN WAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-1532
Practice Address - Country:US
Practice Address - Phone:206-499-8623
Practice Address - Fax:425-203-7217
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC60085387104100000X
WASC60125850104100000X
WALW602827821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALW60282782Medicaid