Healthcare Provider Details

I. General information

NPI: 1194360370
Provider Name (Legal Business Name): JOANNA MANZI-SAKUMA LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2019
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N 36TH ST STE 320
SEATTLE WA
98103-8698
US

IV. Provider business mailing address

432 NE RAVENNA BLVD APT 302
SEATTLE WA
98115-8448
US

V. Phone/Fax

Practice location:
  • Phone: 206-251-8391
  • Fax:
Mailing address:
  • Phone: 206-251-8391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLW00008220
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW61031539
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: