MEDICARE: CARISSA PAULINE PONTING 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
1	1041C0700X	Clinical Social Worker	A13583	OR
2	1041C0700X	Clinical Social Worker	L30039	OR

General Provider Information

NPI Number	:	1396422507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARISSA PAULINE PONTING LCSW

Provider Business Mailing Address
First Line	:	811 JOHN ADAMS ST
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-1956
Country	:	US
Telephone Number	:	971-344-2937
Fax Number	:

Provider Business Practice Location Address
First Line	:	811 JOHN ADAMS ST
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-1956
Country	:	US
Telephone Number	:	971-344-2937
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2023
Last Update Date	:	01/13/2025

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Directions to “ CARISSA PAULINE PONTING LCSW” Practice Location

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