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General NPI Number Information
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NPI Number | 1518257195
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Entity Type | Organization
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Legal Business Name | MARTHA CORONA LLC
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Dates
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Enumeration Date | 04/15/2011
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Last Update Date | 04/15/2011
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Provider Practice Location Address
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Address Line | 5404 N MONTANA AVE
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City | PORTLAND
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State | OR
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Zip | 97217-4557
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Country | US
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Telephone | 503-501-8047
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Fax |
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Provider Business Mailing Address
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Address Line | 1337 TROON DR
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City | WEST LINN
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State | OR
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Zip | 97068-1808
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Country | US
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Telephone | 503-501-8047
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARTHA CORONA-GOLDSTEIN
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Credential | LCSW
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Telephone | 503-701-0076
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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 | L3653
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License Number State | OR
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