Provider Demographics
NPI:1447895263
Name:SIROTA, RICHARD TOBIN
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:TOBIN
Last Name:SIROTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12826 SE 40TH LN STE 203
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-4276
Mailing Address - Country:US
Mailing Address - Phone:206-459-2242
Mailing Address - Fax:
Practice Address - Street 1:12826 SE 40TH LN STE 203
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-4276
Practice Address - Country:US
Practice Address - Phone:206-459-2242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-15
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical