Provider Demographics
NPI:1679946818
Name:BROADWATER, ANDREA (LMHC, CMHS, MHP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:BROADWATER
Suffix:
Gender:F
Credentials:LMHC, CMHS, MHP
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:PINTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8106 35TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-3455
Mailing Address - Country:US
Mailing Address - Phone:425-351-1059
Mailing Address - Fax:
Practice Address - Street 1:8106 35TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-3455
Practice Address - Country:US
Practice Address - Phone:425-351-1059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60393707101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health