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General NPI Number Information
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NPI Number | 1376730986
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Entity Type | Individual
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Provider Name | DEAH RENEE PARTAK LCSW, CADCII
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Gender | Female
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Dates
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Enumeration Date | 09/27/2007
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Last Update Date | 02/13/2024
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Provider Practice Location Address
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Address Line | 3407 S CORBETT AVE
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City | PORTLAND
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State | OR
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Zip | 97239-4621
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Country | US
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Telephone | 503-701-2294
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Fax |
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Provider Business Mailing Address
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Address Line | 16409 SE DIVISION ST STE 216
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City | PORTLAND
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State | OR
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Zip | 97236-1982
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Country | US
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Telephone | 503-701-2294
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 11-06-94
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License Number State | OR
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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 | 4576
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | L4576
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License Number State | OR
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