Healthcare Provider Details

I. General information

NPI: 1710112834
Provider Name (Legal Business Name): LYDIA SAULE HUBER MSW, LICSW, C-SSWS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 05/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33919 9TH AVE S
FEDERAL WAY WA
98003-6742
US

IV. Provider business mailing address

33919- 9TH AVE S
DES MOINES WA
98003
US

V. Phone/Fax

Practice location:
  • Phone: 206-228-3537
  • Fax:
Mailing address:
  • Phone: 206-228-3537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60035034
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number430139F
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: