Provider Demographics
NPI:1841364304
Name:HENRY, REMONY BURLINGAME (LICSW)
Entity type:Individual
Prefix:MS
First Name:REMONY
Middle Name:BURLINGAME
Last Name:HENRY
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:PO BOX 2105
Mailing Address - Street 2:
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070-2105
Mailing Address - Country:US
Mailing Address - Phone:206-463-2945
Mailing Address - Fax:206-463-4714
Practice Address - Street 1:18017 VASHON HWY SW
Practice Address - Street 2:
Practice Address - City:VASHON
Practice Address - State:WA
Practice Address - Zip Code:98070-5205
Practice Address - Country:US
Practice Address - Phone:206-463-2945
Practice Address - Fax:206-463-4714
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000088221041C0700X
CALCS221661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical