Provider Demographics
NPI:1508151291
Name:PAQUETTE, BRUCE (LICSW)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:
Last Name:PAQUETTE
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 1:12625 4TH AVE W
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-6427
Mailing Address - Country:US
Mailing Address - Phone:425-293-0548
Mailing Address - Fax:
Practice Address - Street 1:12625 4TH AVE W
Practice Address - Street 2:SUITE 200
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-6427
Practice Address - Country:US
Practice Address - Phone:425-293-0548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW 000079821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALW 00007982OtherLICENSE