Individual
CHARLES A FANUCCHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
325 W GOWE ST, KENT, WA 98032-5892
(253) 520-9350
(253) 735-4111
Mailing address
2704 I ST NE, AUBURN, WA 98002-2411
(253) 833-7444
(253) 735-4111
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LW00006266
WA
Other
Enumeration date
04/20/2007
Last updated
07/08/2007
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