Healthcare Provider Details

I. General information

NPI: 1023103017
Provider Name (Legal Business Name): ANN MARIE MARTIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANN MARIE CURTIS LCSW

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 SW DOSCH RD
PORTLAND OR
97239
US

IV. Provider business mailing address

PO BOX 6643
ALOHA OR
97007-6643
US

V. Phone/Fax

Practice location:
  • Phone: 503-913-7096
  • Fax:
Mailing address:
  • Phone: 503-913-7096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL2853
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: