Provider Demographics
NPI:1871733345
Name:VANDERHYDE, DORIS MARIE (LICSW)
Entity type:Individual
Prefix:
First Name:DORIS
Middle Name:MARIE
Last Name:VANDERHYDE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:DORIS
Other - Middle Name:
Other - Last Name:BARTEL-VANDERHYDE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:PO BOX 47152
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98146-7152
Mailing Address - Country:US
Mailing Address - Phone:206-683-2742
Mailing Address - Fax:
Practice Address - Street 1:811 1ST AVE STE 466
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-1418
Practice Address - Country:US
Practice Address - Phone:206-683-2742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-24
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000061911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical