Provider Demographics
NPI:1841626686
Name:ROUSSELLE, ROBIN (LICSW)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:ROUSSELLE
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 1:4714 BALLARD AVE NW # 271
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-4850
Mailing Address - Country:US
Mailing Address - Phone:808-281-9456
Mailing Address - Fax:
Practice Address - Street 1:4247 GREENWOOD AVE N APT D
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-7044
Practice Address - Country:US
Practice Address - Phone:808-281-9456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW 602670681041C0700X
HI37641041C0700X
OR53381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical