MEDICARE: NARUSSIA BIANCA DELOACH MSW

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
1	104100000X	Social Worker
2	104100000X	Social Worker	SC61254176	WA
3	1041C0700X	Clinical Social Worker	LW61443848	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215577721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NARUSSIA BIANCA DELOACH MSW

Provider Business Mailing Address
First Line	:	2243 14TH AVE W APT C
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98119-2446
Country	:	US
Telephone Number	:	225-501-4858
Fax Number	:

Provider Business Practice Location Address
First Line	:	2243 14TH AVE W APT C
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98119-2446
Country	:	US
Telephone Number	:	225-938-9980
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2020
Last Update Date	:	01/12/2024

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