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General NPI Number Information
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NPI Number | 1750606828
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Entity Type | Organization
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Legal Business Name | CARLSON, RAY & ASSOCIATES, PS, INC.
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Dates
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Enumeration Date | 04/01/2010
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Last Update Date | 04/01/2010
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Provider Practice Location Address
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Address Line | 2200 112TH AVE NE STE 140
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City | BELLEVUE
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State | WA
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Zip | 98004-2951
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Country | US
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Telephone | 425-454-1189
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Fax |
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Provider Business Mailing Address
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Address Line | 11119 NE 68TH ST
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City | KIRKLAND
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State | WA
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Zip | 98033-7188
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Country | US
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Telephone | 425-454-1189
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ROBERT A CARLSON
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Credential | M.S.W.
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Telephone | 425-454-1189
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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 | LW00004219
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License Number State | WA
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