MEDICARE: MS. SUSAN P PICARD LCSW

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	LW00005960	WA

General Provider Information

NPI Number	:	1336206614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN P PICARD LCSW

Provider Business Mailing Address
First Line	:	500 WALL STREET
Second Line	:	SUITE 322
City	:	SEATTLE
State	:	WA
Zip	:	98121-1508
Country	:	US
Telephone Number	:	206-517-3643
Fax Number	:	206-443-4755

Provider Business Practice Location Address
First Line	:	500 WALL STREET
Second Line	:	SUITE 322
City	:	SEATTLE
State	:	WA
Zip	:	98121-1508
Country	:	US
Telephone Number	:	206-517-3643
Fax Number	:	206-443-4755

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

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	07/08/2007

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