Provider Demographics
NPI:1295892370
Name:STERN, MICHAEL JAY (MSW)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JAY
Last Name:STERN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2917 PACIFIC AVE
Mailing Address - Street 2:STE. 106
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-5307
Mailing Address - Country:US
Mailing Address - Phone:425-252-3133
Mailing Address - Fax:425-252-3103
Practice Address - Street 1:2917 PACIFIC AVE
Practice Address - Street 2:STE. 106
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-5307
Practice Address - Country:US
Practice Address - Phone:425-252-3133
Practice Address - Fax:425-252-3103
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000047101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AB37811Medicare ID - Type Unspecified
R11968Medicare UPIN