MEDICARE: MARTA DRACHENBERG LMHC, R-DMT

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	101YM0800X	Mental Health Counselor	9053	MA
2	101YM0800X	Mental Health Counselor	60564407	WA

General Provider Information

NPI Number	:	1811395007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTA DRACHENBERG LMHC, R-DMT

Provider Business Mailing Address
First Line	:	946 N 90TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-3908
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 WESTLAKE AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98109-3012
Country	:	US
Telephone Number	:	206-283-2220
Fax Number	:

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

Provider Enumeration Date	:	12/20/2014
Last Update Date	:	11/24/2015

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