Healthcare Provider Details

I. General information

NPI: 1124538103
Provider Name (Legal Business Name): SETH R SONENTHAL LICSW, SUDP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2017
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4742 42ND AVE SW UNIT 122
SEATTLE WA
98116-4553
US

IV. Provider business mailing address

4742 42ND AVE SW UNIT 122
SEATTLE WA
98116-4553
US

V. Phone/Fax

Practice location:
  • Phone: 206-403-0173
  • Fax: 206-326-1223
Mailing address:
  • Phone: 206-403-0173
  • Fax: 206-326-1223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60951016
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: