MEDICARE: VIVIAN AGUILERA 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	L3188	OR

General Provider Information

NPI Number	:	1932348661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIAN AGUILERA LCSW

Provider Business Mailing Address
First Line	:	4333 NE CAMPAIGN ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97218-1722
Country	:	US
Telephone Number	:	503-737-9599
Fax Number	:	503-974-1228

Provider Business Practice Location Address
First Line	:	4333 NE CAMPAIGN ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97218-1722
Country	:	US
Telephone Number	:	503-737-9599
Fax Number	:	503-974-1228

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

Provider Enumeration Date	:	02/19/2009
Last Update Date	:	01/11/2023

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