Active NPI
Mathieu Kolacz, LICSW
- Clinical Social Worker
- Mill Creek, WA
National Provider Identifier
1821409426
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LW60432519
- Practice address
- 16000 Bothell Everett Hwy
Suite 360
Mill Creek, WA 98012-1742 - Phone
- (425) 357-9111
- NPI assigned
- May 16, 2014
- Sex
- Male
- Sole proprietor
- No
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 | LW60432519 | WA | Primary |
Addresses
Primary practice location
16000 Bothell Everett Hwy
Suite 360
Mill Creek, WA 98012-1742
Mailing address
17622 16TH PL W
Lynnwood, WA 98037-4001
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
| License | State | Type | Specialty |
|---|---|---|---|
| LW60432519 | WA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mill Creek Family Services, PLLC | 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.
-
- Mental Health Counselor
- Mill Creek, WA
- NPI 1902241623
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1400198400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1400198400000",
"number": "1821409426",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17622 16TH PL W",
"city": "LYNNWOOD",
"state": "WA",
"postal_code": "980374001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16000 BOTHELL EVERETT HWY",
"address_2": "SUITE 360",
"city": "MILL CREEK",
"state": "WA",
"postal_code": "980121742",
"telephone_number": "425-357-9111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOLACZ",
"first_name": "MATHIEU",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-05-16",
"last_updated": "2014-05-16",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WA",
"license": "LW60432519",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mill Creek, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.