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NPI Code Detail

MEDICARE: DOLORES JEANNE MAGGIORE MSW

MEDICARE: DOLORES JEANNE MAGGIORE MSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerL2295OR

General Provider Information

NPI Number : 1164588646
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOLORES JEANNE MAGGIORE MSW
Provider Business Mailing Address
First Line : 5118 SW RICHENBERG CT
Second Line :
City : PORTLAND
State : OR
Zip : 97239-1262
Country : US
Telephone Number : 503-866-0544
Fax Number : 503-221-8764
Provider Business Practice Location Address
First Line : 1305 NE FREMONT ST
Second Line :
City : PORTLAND
State : OR
Zip : 97212-2218
Country : US
Telephone Number : 503-866-0544
Fax Number : 503-221-8764
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2006
Last Update Date : 07/08/2007

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