Healthcare Provider Details

I. General information

NPI: 1467883371
Provider Name (Legal Business Name): AMIR ALEXANDER ASSASNIK LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2013
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16100 NW CORNELL RD # 220
BEAVERTON OR
97006-7334
US

IV. Provider business mailing address

16100 NW CORNELL RD # 220
BEAVERTON OR
97006-7334
US

V. Phone/Fax

Practice location:
  • Phone: 503-878-8885
  • Fax:
Mailing address:
  • Phone: 971-500-6799
  • Fax: 503-922-6676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL10735
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: