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General NPI Number Information
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NPI Number | 1013043785
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Entity Type | Individual
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Provider Name | BETSY E TRUMBULL LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 08/19/2008
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Provider Practice Location Address
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Address Line | 5200 SW MACADAM AVE SUITE 580
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City | PORTLAND
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State | OR
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Zip | 97239-6103
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Country | US
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Telephone | 503-231-7854
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Fax |
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Provider Business Mailing Address
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Address Line | 2803 SE 39TH AVE APT. A
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City | PORTLAND
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State | OR
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Zip | 97202-1611
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Country | US
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Telephone | 503-734-8742
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | A1852
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License Number State | OR
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