Provider Demographics
NPI:1316117146
Name:NASSER, ROBERTA L (MS)
Entity type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:L
Last Name:NASSER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 DEXTER AVE N APT 304
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-2246
Mailing Address - Country:US
Mailing Address - Phone:206-285-8477
Mailing Address - Fax:206-285-8477
Practice Address - Street 1:2450 DEXTER AVE N APT 304
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-2246
Practice Address - Country:US
Practice Address - Phone:206-285-8477
Practice Address - Fax:206-285-8477
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 00005276101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health