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NPI Code Detail

MEDICARE: MS. DEAH RENEE PARTAK LCSW, CADCII

MEDICARE:  MS. DEAH RENEE PARTAK  LCSW, CADCII
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
1101YA0400XAddiction (Substance Use Disorder) Counselor11-06-94OR
21041C0700XClinical Social Worker4576OR
31041C0700XClinical Social WorkerL4576OR

General Provider Information

NPI Number : 1376730986
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DEAH RENEE PARTAK LCSW, CADCII
Provider Business Mailing Address
First Line : 16409 SE DIVISION ST STE 216
Second Line :
City : PORTLAND
State : OR
Zip : 97236-1982
Country : US
Telephone Number : 503-701-2294
Fax Number :
Provider Business Practice Location Address
First Line : 3407 S CORBETT AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97239-4621
Country : US
Telephone Number : 503-701-2294
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2007
Last Update Date : 02/13/2024

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Directions to “ MS. DEAH RENEE PARTAK LCSW, CADCII” Practice Location

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