Healthcare Provider Details

I. General information

NPI: 1174679682
Provider Name (Legal Business Name): MARC FRANCIS CHINARD MS, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 03/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 NE DIVISION ST
GRESHAM OR
97030-4617
US

IV. Provider business mailing address

4544 SE 48TH AVE
PORTLAND OR
97206-4144
US

V. Phone/Fax

Practice location:
  • Phone: 503-666-6575
  • Fax: 503-666-4047
Mailing address:
  • Phone: 503-407-2326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL3147
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: