Provider Demographics
NPI:1922192921
Name:BORNSTEIN, ROZ R (LICSW, MSW)
Entity Type:Individual
Prefix:MS
First Name:ROZ
Middle Name:R
Last Name:BORNSTEIN
Suffix:
Gender:F
Credentials:LICSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19031 33RD AVE W
Mailing Address - Street 2:SUITE 303
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4731
Mailing Address - Country:US
Mailing Address - Phone:425-640-7919
Mailing Address - Fax:425-640-9087
Practice Address - Street 1:19031 33RD AVE W
Practice Address - Street 2:SUITE 303
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4731
Practice Address - Country:US
Practice Address - Phone:425-640-7919
Practice Address - Fax:425-640-9087
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000057001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA20-3529899OtherEIN