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General NPI Number Information
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NPI Number | 1114648136
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Entity Type | Individual
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Provider Name | TARASA ROLAND CSWA
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Gender | Female
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Dates
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Enumeration Date | 09/07/2022
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 7550 N LOMBARD ST APT 315
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City | PORTLAND
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State | OR
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Zip | 97203-3244
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Country | US
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Telephone | 503-208-6188
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Fax |
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Provider Business Mailing Address
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Address Line | 7550 N LOMBARD ST APT 315
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City | PORTLAND
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State | OR
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Zip | 97203-3244
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Country | US
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Telephone | 612-718-3663
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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 | LW61481012
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | L15730
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License Number State | OR
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