Individual provider Active NPI

Laura Martina Eastwick, LICSW, LCSW

  • Clinical Social Worker
  • Lynnwood, WA
National Provider Identifier
1871960864
Registry record updated Oct 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LW61307595 Issued in WA
Practice address
5108 196TH St SW
Lynnwood, WA 98036-6152
Phone
(425) 582-2041
NPI assigned
Aug 26, 2015
Last updated
Oct 20, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LW61307595 WA Primary
Clinical Social Worker 1041C0700X L11328 OR

Addresses

Primary practice location

5108 196TH St SW
Lynnwood, WA 98036-6152

Mailing address

1010 Harris St
Kelso, WA 98626-4512
Phone (617) 510-0025

Other practice location 1

1010 Harris St
Kelso, WA 98626-4512
Phone (617) 510-0025

Other identifiers 1

IdentifierTypeStateIssuer
2140834MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240117004242 WA Practitioner - Clinical Social Worker 7618329467 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
L11328ORMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Pacific Mental Health LLC Mental Health CurrentSince May 1, 2025 Accepting new patients
Pacific Mental Health Oregon LLC Counselor CurrentSince Sep 8, 2025 Accepting new patients
Live Radically, PLLC PastSince Apr 21, 2024 Accepting new patients

Locations

830 NE Holladay St
Portland, OR 97232
Phone (310) 331-0077

5108 196th St SW
Lynnwood, WA 98036
Phone (425) 582-2041

5108 196th St SW
Ste 310
Lynnwood, WA 98036
Phone (425) 582-2041

5108 196th St SW
Ste 350
Lynnwood, WA 98036
Phone (425) 582-2041

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1440547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1792454400000",
    "number": "1871960864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 HARRIS ST",
            "city": "KELSO",
            "state": "WA",
            "postal_code": "986264512",
            "telephone_number": "617-510-0025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5108 196TH ST SW",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980366152",
            "telephone_number": "425-582-2041"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1010 Harris St",
            "address_purpose": "LOCATION",
            "city": "Kelso",
            "state": "WA",
            "postal_code": "986264512",
            "country_code": "US",
            "telephone_number": "617-510-0025",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EASTWICK",
        "first_name": "LAURA",
        "middle_name": "MARTINA",
        "credential": "LICSW, LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-26",
        "last_updated": "2026-10-20",
        "certification_date": "2026-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW61307595",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L11328",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2140834",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lynnwood, WA

Sources for this page

Verify at the official NPI Registry.