Provider Demographics
NPI:1679882682
Name:SHUPACK, MEIRA (MSW LICSW)
Entity Type:Individual
Prefix:MS
First Name:MEIRA
Middle Name:
Last Name:SHUPACK
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 STONEWAY N
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103
Mailing Address - Country:US
Mailing Address - Phone:206-290-1336
Mailing Address - Fax:
Practice Address - Street 1:4010 STONE WAY N
Practice Address - Street 2:SUITE 300
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8099
Practice Address - Country:US
Practice Address - Phone:206-290-1336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-26
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601996481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical