Healthcare Provider Details

I. General information

NPI: 1801147038
Provider Name (Legal Business Name): JOSHUA DAVID OPATOWSKY DSW, LCSW, LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2012
Last Update Date: 03/25/2023
Certification Date: 03/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7347 RAINIER DR
EVERETT WA
98203-5772
US

IV. Provider business mailing address

7347 RAINIER DR
EVERETT WA
98203-5772
US

V. Phone/Fax

Practice location:
  • Phone: 661-886-6046
  • Fax:
Mailing address:
  • Phone: 661-886-6046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number192890
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1451
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW61233547
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12022-C
License Number StateAR
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12784405-3501
License Number StateUT
# 6
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6344
License Number StateND
# 7
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6272
License Number StateOK
# 8
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number80765
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: