Healthcare Provider Details

I. General information

NPI: 1972984003
Provider Name (Legal Business Name): JAMES GORANSON LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 06/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 MLK JR WAY S
SEATTLE WA
98144-4801
US

IV. Provider business mailing address

553 NE 83RD ST
SEATTLE WA
98115-4157
US

V. Phone/Fax

Practice location:
  • Phone: 206-322-7676
  • Fax:
Mailing address:
  • Phone: 206-853-0387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW00004526
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: