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NPI Code Detail

MEDICARE: DANIELLE BUTSCH TRIFONOV LCSW

MEDICARE: DANIELLE BUTSCH TRIFONOV LCSW
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) CounselorICDC.151248-CSOH
2104100000XSocial Worker5596KY
31041C0700XClinical Social WorkerI.1200935.SUPVOH
41041C0700XClinical Social WorkerL7781OR

General Provider Information

NPI Number : 1376775106
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIELLE BUTSCH TRIFONOV LCSW
Provider Business Mailing Address
First Line : PO BOX 3158
Second Line :
City : PORTLAND
State : OR
Zip : 97208-3158
Country : US
Telephone Number : 503-215-6494
Fax Number :
Provider Business Practice Location Address
First Line : 1511 DIVISION ST STE 101
Second Line :
City : OREGON CITY
State : OR
Zip : 97045-1589
Country : US
Telephone Number : 503-722-3705
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2009
Last Update Date : 10/01/2024

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