Provider Demographics
NPI:1801272109
Name:FRAGUELA RIOS, CATHLYN MARIE (LICSW)
Entity type:Individual
Prefix:
First Name:CATHLYN
Middle Name:MARIE
Last Name:FRAGUELA RIOS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:CATHLYN
Other - Middle Name:
Other - Last Name:FRAGUELA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:8856 34TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-3727
Mailing Address - Country:US
Mailing Address - Phone:765-491-1415
Mailing Address - Fax:
Practice Address - Street 1:3400 CALIFORNIA AVE SW # 300
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116
Practice Address - Country:US
Practice Address - Phone:206-320-3399
Practice Address - Fax:206-320-5506
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW606026221041C0700X
WASC60343988104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1801272109Medicaid