Provider Demographics
NPI:1578197604
Name:KUZNETSOVA, YULIYA (LSWAIC)
Entity Type:Individual
Prefix:
First Name:YULIYA
Middle Name:
Last Name:KUZNETSOVA
Suffix:
Gender:F
Credentials:LSWAIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2046 FRANKLIN AVE E # 1
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3534
Mailing Address - Country:US
Mailing Address - Phone:248-860-7461
Mailing Address - Fax:
Practice Address - Street 1:7603 35TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-3229
Practice Address - Country:US
Practice Address - Phone:248-860-7461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC61036516101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health