MEDICARE: MARIAH EILEEN APOLITO MA, LPC, MFT

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	101YP2500X	Professional Counselor	C2487	OR

General Provider Information

NPI Number	:	1659490969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAH EILEEN APOLITO MA, LPC, MFT

Provider Business Mailing Address
First Line	:	516 SE MORRISON ST
Second Line	:	SUITE 500
City	:	PORTLAND
State	:	OR
Zip	:	97214-2327
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	516 SE MORRISON ST
Second Line	:	SUITE 500
City	:	PORTLAND
State	:	OR
Zip	:	97214-2327
Country	:	US
Telephone Number	:	503-453-0763
Fax Number	:

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

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	04/27/2011

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