Healthcare Provider Details

I. General information

NPI: 1609573575
Provider Name (Legal Business Name): ANGELICA T BEDROSIAN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2023
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1902 2ND AVE
SEATTLE WA
98101-1155
US

IV. Provider business mailing address

1902 2ND AVE
SEATTLE WA
98101-1155
US

V. Phone/Fax

Practice location:
  • Phone: 267-901-0284
  • Fax:
Mailing address:
  • Phone: 267-901-0284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number60813640
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberCO61619764
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: