Provider Demographics
NPI:1639230808
Name:STRAZICICH, ROBERT (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:STRAZICICH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 THACKERAY PL NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4842
Mailing Address - Country:US
Mailing Address - Phone:206-675-8757
Mailing Address - Fax:206-545-9223
Practice Address - Street 1:4510 THACKERAY PL NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4842
Practice Address - Country:US
Practice Address - Phone:206-675-8757
Practice Address - Fax:206-545-9223
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002216103TC0700X, 103TC1900X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7089618Medicaid
WA7089618Medicaid