MEDICARE: ROBERTA J DE VITIS LMHC

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	101Y00000X	Counselor	LH00003452	WA

General Provider Information

NPI Number	:	1437376290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERTA J DE VITIS LMHC

Provider Business Mailing Address
First Line	:	14041 25TH AVE NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98125-3411
Country	:	US
Telephone Number	:	206-412-8943
Fax Number	:	206-542-5235

Provider Business Practice Location Address
First Line	:	727 N 182ND ST
Second Line	:	SUITE 202
City	:	SHORELINE
State	:	WA
Zip	:	98133-4402
Country	:	US
Telephone Number	:	206-412-8943
Fax Number	:	206-542-5235

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

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	04/10/2024

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