MEDICARE: MR. NATHANIEL AMOS LICSW

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	1041C0700X	Clinical Social Worker	CW017743	PA
2	1041C0700X	Clinical Social Worker	LW60784137	WA

General Provider Information

NPI Number	:	1609238146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NATHANIEL AMOS LICSW

Provider Business Mailing Address
First Line	:	10102 8TH AVE S
Second Line	:	APT E 036
City	:	SEATTLE
State	:	WA
Zip	:	98168-5505
Country	:	US
Telephone Number	:	267-714-8307
Fax Number	:

Provider Business Practice Location Address
First Line	:	753 N 35TH ST.
Second Line	:	SUITE 308
City	:	SEATTLE
State	:	WA
Zip	:	98103-8873
Country	:	US
Telephone Number	:	267-714-8307
Fax Number	:

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

Provider Enumeration Date	:	03/23/2016
Last Update Date	:	04/11/2020

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