MEDICARE: JOAN LAGUZZA MSW, 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	104100000X	Social Worker
2	1041C0700X	Clinical Social Worker	L7761	OR

General Provider Information

NPI Number	:	1477941110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOAN LAGUZZA MSW, LCSW

Provider Business Mailing Address
First Line	:	1300 SW PARK AVE APT 2316
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97201-3663
Country	:	US
Telephone Number	:	571-278-2063
Fax Number	:

Provider Business Practice Location Address
First Line	:	15110 BOONES FERRY RD STE 350
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97035-3461
Country	:	US
Telephone Number	:	571-278-2063
Fax Number	:

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

Provider Enumeration Date	:	01/05/2015
Last Update Date	:	10/22/2021

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