Healthcare Provider Details

I. General information

NPI: 1740059328
Provider Name (Legal Business Name): CAROLYN ROSE BARTOLONE LSWAIC
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/25/2023
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 S PLUM ST
SEATTLE WA
98144-4539
US

IV. Provider business mailing address

4740 32ND AVE S APT 306
SEATTLE WA
98118-2194
US

V. Phone/Fax

Practice location:
  • Phone: 206-441-3043
  • Fax:
Mailing address:
  • Phone: 708-262-1629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number61441076
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWIA.SC.61441076
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: