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General NPI Number Information
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NPI Number | 1831429646
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Entity Type | Individual
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Provider Name | YULYA TRINIDAD LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/30/2009
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Last Update Date | 03/24/2020
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Provider Practice Location Address
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Address Line | 1438 SE DIVISION ST
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City | PORTLAND
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State | OR
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Zip | 97202-1140
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Country | US
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Telephone | 503-548-0346
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Fax | 503-232-5959
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Provider Business Mailing Address
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Address Line | 1776 SW MADISON ST
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City | PORTLAND
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State | OR
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Zip | 97205-1715
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Country | US
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Telephone | 503-224-1044
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Fax | 503-621-2235
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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 | L6511
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License Number State | OR
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