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NPI Code Detail

MEDICARE: SARA MARGARET DRYDEN MSW, LCSW, QMHP

MEDICARE: SARA MARGARET DRYDEN MSW, LCSW, QMHP
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
1101YM0800XMental Health Counselor
21041C0700XClinical Social WorkerL6150OR

General Provider Information

NPI Number : 1649451766
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARA MARGARET DRYDEN MSW, LCSW, QMHP
Provider Business Mailing Address
First Line : PO BOX 8459
Second Line :
City : PORTLAND
State : OR
Zip : 97207-8459
Country : US
Telephone Number : 503-238-0769
Fax Number : 503-552-6208
Provider Business Practice Location Address
First Line : 1825 NE GLISAN ST
Second Line :
City : PORTLAND
State : OR
Zip : 97232-2844
Country : US
Telephone Number : 503-963-7676
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2007
Last Update Date : 01/22/2020

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