Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | L4219 | OR |
NPI | 1003118761 |
---|---|
Provider Name | Greg Newman |
First Address | Oregon City, OR 97045-3788 |
Second Address | Oregon City, OR 97045-3788 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2010 |
Last Update Date | 16/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1104253079 | (05) | OR |