Provider Demographics
NPI:1982026654
Name:MANN, PHILLIP (LCSW)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:MANN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6216 35TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-7315
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6061 WELLESLEY WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-7626
Practice Address - Country:US
Practice Address - Phone:206-218-7716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-14
Last Update Date:2022-07-07
Deactivation Date:2022-02-24
Deactivation Code:
Reactivation Date:2022-04-20
Provider Licenses
StateLicense IDTaxonomies
WASC 60301761104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker