Healthcare Provider Details

I. General information

NPI: 1730453978
Provider Name (Legal Business Name): GEETIKA AGARWAL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2012
Last Update Date: 05/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 6TH AVE N
SEATTLE WA
98109-3913
US

IV. Provider business mailing address

821 6TH AVE N
SEATTLE WA
98109-3913
US

V. Phone/Fax

Practice location:
  • Phone: 678-814-7994
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY60517719
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-11-9001
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: