Provider Demographics
NPI:1528682440
Name:PERINATAL SUPPORT WASHINGTON
Entity type:Organization
Organization Name:PERINATAL SUPPORT WASHINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MIA
Authorized Official - Middle Name:
Authorized Official - Last Name:EDIDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-404-7763
Mailing Address - Street 1:2311 N 45TH ST # 239
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-6905
Mailing Address - Country:US
Mailing Address - Phone:888-404-7763
Mailing Address - Fax:
Practice Address - Street 1:2319 N 45TH ST STE 303
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6979
Practice Address - Country:US
Practice Address - Phone:888-404-7763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty