Healthcare Provider Details

I. General information

NPI: 1912019787
Provider Name (Legal Business Name): DOROTHY ELLEN ABELSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2290 OAKMONT WAY
EUGENE OR
97401-5519
US

IV. Provider business mailing address

899 CLASSIC PL
EUGENE OR
97401-5115
US

V. Phone/Fax

Practice location:
  • Phone: 541-484-9722
  • Fax:
Mailing address:
  • Phone: 541-343-8603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0748
License Number StateOR

VII. Legacy identifiers

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

# 1
IdentifierJ9100
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerPACIFICSOURCE HEALTH PLAN
# 2
IdentifierR03099
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerPACIFICARE BEHAVIORAL HEA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: