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General NPI Number Information
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NPI Number | 1679106744
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Entity Type | Individual
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Provider Name | ADAM R VON PASSOW LCSW
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Gender | Male
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Dates
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Enumeration Date | 02/18/2020
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Last Update Date | 02/18/2020
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Provider Practice Location Address
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Address Line | 0333 SW FLOWER ST
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City | PORTLAND
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State | OR
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Zip | 97239-3754
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Country | US
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Telephone | 503-349-2281
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Fax |
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Provider Business Mailing Address
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Address Line | 4243 SE NEHALEM ST
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City | PORTLAND
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State | OR
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Zip | 97206-0947
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Country | US
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Telephone | 310-593-1672
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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 | 7429
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License Number State | OR
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