Provider Demographics
NPI:1518447630
Name:FONTANA, ROBERT MATTHEW (MFT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MATTHEW
Last Name:FONTANA
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 NE 58TH ST APT B
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-2440
Mailing Address - Country:US
Mailing Address - Phone:509-731-6012
Mailing Address - Fax:
Practice Address - Street 1:1827 NE 58TH ST # B
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-2440
Practice Address - Country:US
Practice Address - Phone:206-651-5058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG60653229103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling