Provider Demographics
NPI:1609573575
Name:BEDROSIAN, ANGELICA T (LICSW)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:T
Last Name:BEDROSIAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1155
Mailing Address - Country:US
Mailing Address - Phone:267-901-0284
Mailing Address - Fax:
Practice Address - Street 1:1902 2ND AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1155
Practice Address - Country:US
Practice Address - Phone:267-901-0284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60813640104100000X
WACO61619764390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program