Basic Information
Provider Information | |||||||||
NPI: | 1942217898 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MCGRATH | ||||||||
FirstName: | DORIANNE | ||||||||
MiddleName: | L | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | LICSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | LIVINGSTON | ||||||||
OtherFirstName: | DORIANNE | ||||||||
OtherMiddleName: | M | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | RC | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 5299 | ||||||||
Address2: | MS: 737-2-PHYS | ||||||||
City: | TACOMA | ||||||||
State: | WA | ||||||||
PostalCode: | 984150299 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2534597970 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 315 MARTIN LUTHER KING JR WAY | ||||||||
Address2: |   | ||||||||
City: | TACOMA | ||||||||
State: | WA | ||||||||
PostalCode: | 984054234 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2534031000 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/02/2006 | ||||||||
LastUpdateDate: | 12/21/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | RC00050636 | WA | N |   | Behavioral Health & Social Service Providers | Social Worker |   | 1041C0700X | LW00009579 | WA | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.