Healthcare Provider Details

I. General information

NPI: 1225157340
Provider Name (Legal Business Name): PAUL LEIBOWITZ L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 SW 11TH AVE SUITE 320
PORTLAND OR
97205-2125
US

IV. Provider business mailing address

17675 SW FARMINGTON RD PMB 188
ALOHA OR
97007-3208
US

V. Phone/Fax

Practice location:
  • Phone: 503-248-2298
  • Fax: 503-848-6101
Mailing address:
  • Phone: 503-591-8322
  • Fax: 503-848-6101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW1709
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: