Provider Demographics
NPI:1184044109
Name:BICOFF- SMIT, ANSEBE
Entity type:Individual
Prefix:
First Name:ANSEBE
Middle Name:
Last Name:BICOFF- SMIT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANSEBE
Other - Middle Name:
Other - Last Name:SMIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:905 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2042
Mailing Address - Country:US
Mailing Address - Phone:206-235-1608
Mailing Address - Fax:
Practice Address - Street 1:901 BOREN AVE STE 701
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3508
Practice Address - Country:US
Practice Address - Phone:240-516-6762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-17
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health