MEDICARE: DANIT LIDOR LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	L10959	OR

General Provider Information

NPI Number	:	1497476113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIT LIDOR LCSW

Provider Business Mailing Address
First Line	:	1306 NW HOYT ST STE 407
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97209-2787
Country	:	US
Telephone Number	:	503-433-6118
Fax Number	:

Provider Business Practice Location Address
First Line	:	3115 NE SANDY BLVD STE 225
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-2777
Country	:	US
Telephone Number	:	971-407-3930
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2022
Last Update Date	:	09/09/2022

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