Healthcare Provider Details

I. General information

NPI: 1629100334
Provider Name (Legal Business Name): ALAN WERKMAN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 09/23/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SW BLUFF DR
BEND OR
97702-1696
US

IV. Provider business mailing address

65300 85TH ST
BEND OR
97703-8944
US

V. Phone/Fax

Practice location:
  • Phone: 541-815-9110
  • Fax: 458-666-1875
Mailing address:
  • Phone: 541-815-9110
  • Fax: 458-666-1875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL3403
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: