MEDICARE: CARLY BIROS 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	L17941	OR
2	1041C0700X	Clinical Social Worker	101103	CA

General Provider Information

NPI Number	:	1619443413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLY BIROS LCSW

Provider Business Mailing Address
First Line	:	3258 NE SKIDMORE ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97211-7747
Country	:	US
Telephone Number	:	949-547-0205
Fax Number	:

Provider Business Practice Location Address
First Line	:	3258 NE SKIDMORE ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97211-7747
Country	:	US
Telephone Number	:	949-547-0205
Fax Number	:

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

Provider Enumeration Date	:	10/18/2018
Last Update Date	:	04/28/2026

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Directions to “ CARLY BIROS LCSW” Practice Location

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