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NPI Code Detail

MEDICARE: STEPHANIE MARIE FRAGOSO REYES

MEDICARE: STEPHANIE MARIE FRAGOSO REYES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor60876338WA

General Provider Information

NPI Number : 1033692454
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE MARIE FRAGOSO REYES
Provider Business Mailing Address
First Line : 3808 S ANGELINE ST
Second Line :
City : SEATTLE
State : WA
Zip : 98118-1712
Country : US
Telephone Number : 206-461-4880
Fax Number :
Provider Business Practice Location Address
First Line : 3808 S ANGELINE ST
Second Line :
City : SEATTLE
State : WA
Zip : 98118-1712
Country : US
Telephone Number : 206-461-4880
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2018
Last Update Date : 01/27/2020

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Directions to “ STEPHANIE MARIE FRAGOSO REYES ” Practice Location

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