Individual provider Active NPI

Stefanie Serafine

  • Clinical Social Worker
  • Walla Walla, WA
National Provider Identifier
1760096879
Registry record updated Sep 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
SC61083876 Issued in WA
Practice address
2330 Eastgate St Ste 207
Walla Walla, WA 99362-1559
Phone
(509) 593-8122
Fax
(509) 769-5221
NPI assigned
Sep 4, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X SC61083876 WA Primary

Addresses

Primary practice location

2330 Eastgate St Ste 207
Walla Walla, WA 99362-1559

Mailing address

2330 Eastgate St Ste 207
Walla Walla, WA 99362-1559
Phone (509) 593-8122

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

State licenses

LicenseStateTypeSpecialty
SC61083876WAMDClinical Social Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1599177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599177600000",
    "number": "1760096879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2330 EASTGATE ST STE 207",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993621559",
            "telephone_number": "509-593-8122",
            "fax_number": "509-769-5221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2330 EASTGATE ST STE 207",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993621559",
            "telephone_number": "509-593-8122",
            "fax_number": "509-769-5221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SERAFINE",
        "first_name": "STEFANIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-04",
        "last_updated": "2020-09-04",
        "certification_date": "2020-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "SC61083876",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Walla Walla, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.