Healthcare Provider Details

I. General information

NPI: 1912379603
Provider Name (Legal Business Name): CATHERINE HENNESSY L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2015
Last Update Date: 10/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 SW BOND AVE CH7A
PORTLAND OR
97239-4501
US

IV. Provider business mailing address

3303 SW BOND AVE CH7A
PORTLAND OR
97239-4501
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-9244
  • Fax: 503-494-5385
Mailing address:
  • Phone: 503-494-9244
  • Fax: 503-494-5385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL3299
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: