Provider Demographics
NPI:1619164407
Name:SHIRAEV, NICOLE THERESE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:THERESE
Last Name:SHIRAEV
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:THERESE
Other - Last Name:STEWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:150 NICKERSON ST
Mailing Address - Street 2:SUITE #105
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-1634
Mailing Address - Country:US
Mailing Address - Phone:540-808-5343
Mailing Address - Fax:
Practice Address - Street 1:150 NICKERSON ST
Practice Address - Street 2:SUITE #105
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-1634
Practice Address - Country:US
Practice Address - Phone:540-808-5343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040065061041C0700X
WALW600913241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical