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General NPI Number Information
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NPI Number | 1740680909
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Entity Type | Individual
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Provider Name | EDOUARD NIEDENTHAL DURET
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Gender | Male
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Dates
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Enumeration Date | 08/25/2014
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Last Update Date | 01/05/2025
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Provider Practice Location Address
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Address Line | 5441 S MACADAM AVE STE N
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City | PORTLAND
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State | OR
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Zip | 97239-6106
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Country | US
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Telephone | 971-433-2978
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Fax | 458-216-8051
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Provider Business Mailing Address
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Address Line | 5441 S MACADAM AVE STE N
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City | PORTLAND
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State | OR
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Zip | 97239-6106
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Country | US
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Telephone | 971-433-2978
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Fax | 458-216-8051
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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 | LCSW117885
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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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 | L11117
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License Number State | OR
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