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NPI Code Detail

MEDICARE: JENNIFER MANEY MSW, LCSW

MEDICARE: JENNIFER MANEY 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
11041C0700XClinical Social WorkerL3893OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1L3893OTHERORLCSW

General Provider Information

NPI Number : 1730302670
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER MANEY MSW, LCSW
Provider Business Mailing Address
First Line : 209 SW 4TH AVE STE 520
Second Line :
City : PORTLAND
State : OR
Zip : 97204-1825
Country : US
Telephone Number : 503-988-3999
Fax Number :
Provider Business Practice Location Address
First Line : 209 SW 4TH AVE STE 520
Second Line :
City : PORTLAND
State : OR
Zip : 97204-1825
Country : US
Telephone Number : 503-988-3999
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2007
Last Update Date : 11/15/2021

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