Provider Demographics
NPI:1801018098
Name:PACE, CYNTHIA ANNE (LICSW)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ANNE
Last Name:PACE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:
Other - Last Name:PACE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7052 DIBBLE AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-5121
Mailing Address - Country:US
Mailing Address - Phone:206-782-7134
Mailing Address - Fax:
Practice Address - Street 1:407 N 45TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6401
Practice Address - Country:US
Practice Address - Phone:206-547-5614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000048171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical