MEDICARE: ROBERTO OELSNER AND MIRTA BERMAN-OELSNER FIPA PLLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	LH601637728	WA

General Provider Information

NPI Number	:	1457639783
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERTO OELSNER AND MIRTA BERMAN-OELSNER FIPA PLLC

Provider Business Mailing Address
First Line	:	4119 DAYTON AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-7722
Country	:	US
Telephone Number	:	206-441-3667
Fax Number	:	206-374-3721

Provider Business Practice Location Address
First Line	:	4119 DAYTON AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-7722
Country	:	US
Telephone Number	:	206-441-3667
Fax Number	:	206-374-3721

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ROBERTO RAUL OELSNER
Credential	:	LMHC
Telephone Number	:	206-441-3667

Provider Enumeration Date	:	08/03/2011
Last Update Date	:	08/03/2011

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