Healthcare Provider Details

I. General information

NPI: 1548021843
Provider Name (Legal Business Name): AMY RAPPAPORT LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2024
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BEIT YOSEPH 12
ZEFAT ISRAEL
1310000
IL

IV. Provider business mailing address

1916 PIKE PL
SEATTLE WA
98101-1056
US

V. Phone/Fax

Practice location:
  • Phone: 972-502-8185
  • Fax:
Mailing address:
  • Phone: 50-281-8553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number122481
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: