Active NPI
Susan Moini, LICSW
- Clinical Social Worker
- Kirkland, WA
National Provider Identifier
1295069540
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LW00009062
- Practice address
- 11415 NE 128TH St
Suite 100
Kirkland, WA 98034-6314 - Phone
- (425) 773-3677
- NPI assigned
- Sep 18, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LW00009062 | WA | Primary |
Addresses
Primary practice location
11415 NE 128TH St
Suite 100
Kirkland, WA 98034-6314
Mailing address
11415 NE 128TH St
Suite 100
Kirkland, WA 98034-6314
Phone (425) 773-3677
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 2, 2024 through Apr 2, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LW00009062 | WA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1253232000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1297814400000",
"number": "1295069540",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11415 NE 128TH ST",
"address_2": "SUITE 100",
"city": "KIRKLAND",
"state": "WA",
"postal_code": "980346314",
"telephone_number": "425-773-3677"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11415 NE 128TH ST",
"address_2": "SUITE 100",
"city": "KIRKLAND",
"state": "WA",
"postal_code": "980346314",
"telephone_number": "425-773-3677"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOINI",
"first_name": "SUSAN",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-09-18",
"last_updated": "2011-02-16",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WA",
"license": "LW00009062",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kirkland, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.