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NPI Code Detail

MEDICARE: CHARLES A FANUCCHI LSW

MEDICARE: CHARLES A FANUCCHI LSW
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
11041C0700XClinical Social WorkerLW00006266WA

General Provider Information

NPI Number : 1346468964
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES A FANUCCHI LSW
Provider Business Mailing Address
First Line : 2704 I ST NE
Second Line :
City : AUBURN
State : WA
Zip : 98002-2411
Country : US
Telephone Number : 253-833-7444
Fax Number : 253-735-4111
Provider Business Practice Location Address
First Line : 325 W GOWE ST
Second Line :
City : KENT
State : WA
Zip : 98032-5892
Country : US
Telephone Number : 253-520-9350
Fax Number : 253-735-4111
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2007
Last Update Date : 07/08/2007

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Directions to “ CHARLES A FANUCCHI LSW” Practice Location

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