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General NPI Number Information
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NPI Number | 1568901114
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Entity Type | Individual
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Provider Name | MICHAEL PAINE
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Gender | Male
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Dates
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Enumeration Date | 02/15/2017
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Last Update Date | 02/15/2017
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Provider Practice Location Address
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Address Line | 17018 15TH AVE NE
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City | SHORELINE
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State | WA
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Zip | 98155-5126
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Country | US
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Telephone | 206-554-1769
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Fax |
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Provider Business Mailing Address
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Address Line | 101 TAYLOR AVE N APT 504
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City | SEATTLE
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State | WA
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Zip | 98109-5146
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Country | US
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Telephone | 206-779-5369
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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