Healthcare Provider Details

I. General information

NPI: 1437326220
Provider Name (Legal Business Name): BRIAN A KIERNAN LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BRIAN E TAYLOR

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 09/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 16TH AVE STE 100
SEATTLE WA
98122-5699
US

IV. Provider business mailing address

PO BOX 84026
SEATTLE WA
98124-8426
US

V. Phone/Fax

Practice location:
  • Phone: 206-320-2484
  • Fax: 206-320-4568
Mailing address:
  • Phone: 206-320-2484
  • Fax: 206-320-4568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60099997
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: