Healthcare Provider Details

I. General information

NPI: 1568778553
Provider Name (Legal Business Name): ANTHONY J CARR MSW, CSWA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2010
Last Update Date: 08/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 SW ADAMS AVE
HILLSBORO OR
97123-3874
US

IV. Provider business mailing address

215 SW ADAMS AVE
HILLSBORO OR
97123-3874
US

V. Phone/Fax

Practice location:
  • Phone: 503-846-6354
  • Fax:
Mailing address:
  • Phone: 704-939-1118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberA4794
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: