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General NPI Number Information
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NPI Number | 1689967184
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Entity Type | Individual
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Provider Name | CHE BLAINE M.S.W., L.I.C.S.W.
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Gender | Male
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Dates
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Enumeration Date | 05/17/2011
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Last Update Date | 05/17/2011
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Provider Practice Location Address
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Address Line | 543 NORTH BEACH ROAD
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City | EASTSOUND
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State | WA
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Zip | 98245
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Country | US
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Telephone | 360-376-4222
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 477
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City | EASTSOUND
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State | WA
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Zip | 98245-0477
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Country | US
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Telephone | 360-376-4222
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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 | LW00006118
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License Number State | WA
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