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General NPI Number Information
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NPI Number | 1114390010
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Entity Type | Individual
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Provider Name | R. D. SUZ FORETICH LICSW
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Gender | Female
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Dates
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Enumeration Date | 11/02/2015
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Last Update Date | 06/27/2019
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Provider Practice Location Address
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Address Line | 2366 EASTLAKE AVE E STE 320
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City | SEATTLE
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State | WA
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Zip | 98102-3399
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Country | US
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Telephone | 206-790-1843
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Fax |
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Provider Business Mailing Address
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Address Line | 2366 EASTLAKE AVE E STE 320
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City | SEATTLE
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State | WA
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Zip | 98102-3399
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Country | US
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Telephone | 206-790-1843
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SC60584558
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LW60907426
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License Number State | WA
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