Active NPI
Paul Michael Stayback, LICSWA
- Clinical Social Worker
- Snohomish, WA
National Provider Identifier
1336749589
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Practice address
- 16668 132ND St SE
Snohomish, WA 98290-6767 - Phone
- (201) 696-1165
- NPI assigned
- Oct 27, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Social Worker | 1041S0200X | |||
| Mental Health Counselor | 101YM0800X | |||
| Counselor | 101Y00000X | |||
| Case Manager/Care Coordinator | 171M00000X | |||
| Clinical Social Worker | 1041C0700X | Primary |
Addresses
Primary practice location
16668 132ND St SE
Snohomish, WA 98290-6767
Mailing address
16668 132ND St SE
Snohomish, WA 98290-6767
Phone (201) 696-1165
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Resilience Behavioral Health | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Psychiatric/Mental Health Nurse Practitioner
- Everett, WA
- NPI 1336996388
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1603756800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1770163200000",
"number": "1336749589",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16668 132ND ST SE",
"city": "SNOHOMISH",
"state": "WA",
"postal_code": "982906767",
"telephone_number": "201-696-1165"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16668 132ND ST SE",
"city": "SNOHOMISH",
"state": "WA",
"postal_code": "982906767",
"telephone_number": "201-696-1165"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STAYBACK",
"first_name": "PAUL",
"middle_name": "MICHAEL",
"credential": "LICSWA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-10-27",
"last_updated": "2026-02-04",
"certification_date": "2026-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "1041S0200X",
"taxonomy_group": "",
"desc": "Social Worker, School",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Snohomish, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.