Provider Demographics
NPI:1790376127
Name:CORTAZAR, PATRICIA (LICSW)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:CORTAZAR
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 1:33301 1ST WAY S STE C140
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6252
Mailing Address - Country:US
Mailing Address - Phone:253-431-9739
Mailing Address - Fax:
Practice Address - Street 1:33301 1ST WAY S STE C140
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6252
Practice Address - Country:US
Practice Address - Phone:253-213-6451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW614548371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty