MEDICARE: MARIA AGNE LICSW, MSW, MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LW00009338	WA

General Provider Information

NPI Number	:	1285819433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA AGNE LICSW, MSW, MA

Provider Business Mailing Address
First Line	:	702 MARTIN LUTHER KING JR WAY S
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98144-3112
Country	:	US
Telephone Number	:	206-778-4735
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 19TH AVE E
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98112-3505
Country	:	US
Telephone Number	:	206-778-4735
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/07/2008
Last Update Date	:	01/07/2008

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