Provider Demographics
NPI:1629340989
Name:BRODSKY CHASE, GENNA (LICSW)
Entity Type:Individual
Prefix:
First Name:GENNA
Middle Name:
Last Name:BRODSKY CHASE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 STATE AVE NE
Mailing Address - Street 2:PMB #203
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-1131
Mailing Address - Country:US
Mailing Address - Phone:925-338-9817
Mailing Address - Fax:
Practice Address - Street 1:222 KENYON ST NW
Practice Address - Street 2:SUITE #1
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502
Practice Address - Country:US
Practice Address - Phone:925-338-9817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293941041C0700X
WA611540291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical