Provider Demographics
NPI:1992193304
Name:LANDES BIFONE, JOANNA (LICSW)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:LANDES BIFONE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2585 4TH AVE W
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-2369
Mailing Address - Country:US
Mailing Address - Phone:206-419-0390
Mailing Address - Fax:
Practice Address - Street 1:11911 NE 1ST ST
Practice Address - Street 2:SUITE 206
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-3055
Practice Address - Country:US
Practice Address - Phone:425-453-7890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000048921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical