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General NPI Number Information
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NPI Number | 1740103548
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Entity Type | Individual
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Provider Name | DERRICK LONG
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Gender | Male
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Dates
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Enumeration Date | 07/30/2026
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Last Update Date | 07/30/2026
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Provider Practice Location Address
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Address Line | 4110 NE 122ND AVE
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City | PORTLAND
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State | OR
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Zip | 97230-1300
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Country | US
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Telephone | 971-227-3553
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Fax |
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Provider Business Mailing Address
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Address Line | 20679 SW EDGEMONT ST
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City | BEAVERTON
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State | OR
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Zip | 97003-6048
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Country | US
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Telephone |
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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 |
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License Number State | OR
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