Healthcare Provider Details

I. General information

NPI: 1417256744
Provider Name (Legal Business Name): PHILLIP CARR LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2011
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8400 5TH AVE NE UNIT 8
SEATTLE WA
98115-4163
US

IV. Provider business mailing address

8400 5TH AVE NE UNIT 8
SEATTLE WA
98115-4163
US

V. Phone/Fax

Practice location:
  • Phone: 206-954-3348
  • Fax: 206-566-6913
Mailing address:
  • Phone: 206-954-3348
  • Fax: 206-566-6913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSC60189451
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60494715
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: