Healthcare Provider Details

I. General information

NPI: 1679635817
Provider Name (Legal Business Name): EMILY LUCILLE PUMA MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 10/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 9TH AVE HARBORVIEW
SEATTLE WA
98104-2420
US

IV. Provider business mailing address

325 9TH AVE HARBORVIEW
SEATTLE WA
98104-2420
US

V. Phone/Fax

Practice location:
  • Phone: 206-744-9697
  • Fax: 206-744-9919
Mailing address:
  • Phone: 206-744-9697
  • Fax: 206-744-9919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLW00009456
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW00009456
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: