Healthcare Provider Details

I. General information

NPI: 1750564423
Provider Name (Legal Business Name): ISRAEL LEE PAINTER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2007
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 NE NORTON AVE STE 2
BEND OR
97701-4386
US

IV. Provider business mailing address

336 NE NORTON AVE STE 2
BEND OR
97701-4386
US

V. Phone/Fax

Practice location:
  • Phone: 541-948-7499
  • Fax: 888-972-8921
Mailing address:
  • Phone: 541-948-7499
  • Fax: 888-972-8921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL3736
License Number StateOR

VII. Legacy identifiers

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

# 1
Identifier500804603
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: