Healthcare Provider Details

I. General information

NPI: 1598724981
Provider Name (Legal Business Name): LAWRENCE JEFFREY MALTZ LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: LARRY MALTZ LCSW

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 03/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2895 OAK ST SUITE B
EUGENE OR
97405-3694
US

IV. Provider business mailing address

2895 OAK ST SUITE B
EUGENE OR
97405-3694
US

V. Phone/Fax

Practice location:
  • Phone: 541-484-4480
  • Fax: 541-345-2767
Mailing address:
  • Phone: 541-484-4480
  • Fax: 541-345-2767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number397
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: