Provider Demographics
NPI:1356529036
Name:ROSENFELD, AUDREY KIM (LICSW)
Entity type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:KIM
Last Name:ROSENFELD
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 1:3020 ISSAQUAH PINE LAKE RD SE
Mailing Address - Street 2:315
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98075-7253
Mailing Address - Country:US
Mailing Address - Phone:425-557-0907
Mailing Address - Fax:425-557-0940
Practice Address - Street 1:1400 112TH AVE SE
Practice Address - Street 2:100
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6901
Practice Address - Country:US
Practice Address - Phone:425-557-0907
Practice Address - Fax:425-557-0940
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000052711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical