| |
2719 E Madison St Ste 200 Seattle WA 98112-4752 | |
(206) 683-0707 | |
(206) 299-0766 |
Full Name | |
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Speciality | Counselor |
Location | 2719 E Madison St Ste 200, Seattle, Washington |
Authorized Official Name and Position | Amanda Sue Moening (PEOPLE OPS AND DATA MANAGER) |
Authorized Official Contact | 5673561646 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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2719 E Madison St Ste 200 Seattle WA 98112-4752 Ph: (206) 683-0707 | 2719 E Madison St Ste 200 Seattle WA 98112-4752 Ph: (206) 683-0707 |
NPI Number | 1750934071 |
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Provider Enumeration Date | 07/17/2019 |
Last Update Date | 10/09/2024 |
Certification Date | 10/09/2024 |
Medicare PECOS PAC ID | 6709270341 |
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Medicare Enrollment ID | O20241028000331 |
Identifier | Type | State | Issuer |
---|---|---|---|
1750934071 | NPI | - | NPPES |
2034686 | Medicaid | WA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
Provider Name | Ralph A. Fragale |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1073781027 PECOS PAC ID: 4981098522 Enrollment ID: I20241028000848 |
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