Healthcare Provider Details

I. General information

NPI: 1720657851
Provider Name (Legal Business Name): LAVINIA PAOLA MAGLIOCCO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1722 NW RALEIGH ST # 201
PORTLAND OR
97209-1753
US

IV. Provider business mailing address

LUTHERAN COMMUNITY SERVICES 605 SE CESAR E CHAVEZ BLVD
PORTLAND OR
97214
US

V. Phone/Fax

Practice location:
  • Phone: 503-887-3608
  • Fax:
Mailing address:
  • Phone: 503-231-7480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC8691
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: