Provider Demographics
NPI:1780066381
Name:LASBY, CARMEN DANIELLE (MA; PSYD)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:DANIELLE
Last Name:LASBY
Suffix:
Gender:F
Credentials:MA; PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3417 FREMONT AVE N STE 305
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-3411
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3417 FREMONT AVE N
Practice Address - Street 2:317
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-3411
Practice Address - Country:US
Practice Address - Phone:206-300-2452
Practice Address - Fax:206-547-5298
Is Sole Proprietor?:No
Enumeration Date:2015-06-19
Last Update Date:2017-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC 60462365101YM0800X
WAPY60654578103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health