Provider Demographics
NPI:1770988354
Name:NICOLE T SHIRAEV, LICSW, PLLC
Entity type:Organization
Organization Name:NICOLE T SHIRAEV, LICSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST/SOLE PROPRIETOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:T
Authorized Official - Last Name:SHIRAEV
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:540-808-5343
Mailing Address - Street 1:150 NICKERSON ST
Mailing Address - Street 2:SUITE #105
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-1634
Mailing Address - Country:US
Mailing Address - Phone:540-808-5343
Mailing Address - Fax:
Practice Address - Street 1:150 NICKERSON ST
Practice Address - Street 2:SUITE #105
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-1634
Practice Address - Country:US
Practice Address - Phone:540-808-5343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-25
Last Update Date:2014-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW600913241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1619164407OtherINDIVIDUAL NPI