Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | ||
Y | 103T00000X | Psychologist | ||
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 1801 | OR |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 1801 | OR |
N | 103G00000X | Clinical Psychologist | 1801 | OR |
N | 103TC0700X | Clinical Psychologist | 1801 | OR |
N | 103TH0004X | Health Psychologist | 1801 | OR |
NPI | 1366526212 |
---|---|
Provider Name | Dr. Benjamin J. Morasco |
First Address | Portland, OR 97239-2964 |
Second Address | Portland, OR 97239-2964 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 01/11/2007 |