MEDICARE: ANDREW P. PRICE LCSW, LLC

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	3344	OR

General Provider Information

NPI Number	:	1740391770
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDREW P. PRICE LCSW, LLC

Provider Business Mailing Address
First Line	:	2304 E BURNSIDE ST
Second Line	:	STE. #202
City	:	PORTLAND
State	:	OR
Zip	:	97214-1677
Country	:	US
Telephone Number	:	503-238-6007
Fax Number	:	503-238-6007

Provider Business Practice Location Address
First Line	:	2304 E BURNSIDE ST
Second Line	:	STE. #202
City	:	PORTLAND
State	:	OR
Zip	:	97214-1677
Country	:	US
Telephone Number	:	503-238-6007
Fax Number	:	503-238-6007

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	ANDREW PRICE
Credential	:	MSW, LCSW
Telephone Number	:	503-238-6007

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	08/22/2020

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