Basic Information
Provider Information | |||||||||
NPI: | 1063695955 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | COREY | ||||||||
FirstName: | AMY | ||||||||
MiddleName: | H. | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | LICSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | GLASSER | ||||||||
OtherFirstName: | AMY | ||||||||
OtherMiddleName: | H. | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 24366 | ||||||||
Address2: |   | ||||||||
City: | SEATTLE | ||||||||
State: | WA | ||||||||
PostalCode: | 981240366 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2065980502 | ||||||||
FaxNumber: | 2065980516 | ||||||||
Practice Location | |||||||||
Address1: | 1959 NE PACIFIC ST | ||||||||
Address2: | BOX 356125 | ||||||||
City: | SEATTLE | ||||||||
State: | WA | ||||||||
PostalCode: | 981950001 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2065984374 | ||||||||
FaxNumber: | 2065986333 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/13/2007 | ||||||||
LastUpdateDate: | 12/13/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LW00005358 | WA | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.