Unknown Individual – Psychiatry Physician, NPI 1083728976
Psychiatry Physician
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NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
CCC Administration Office, 232, Northwest 6th Avenue, Chinatown, Old Town, Portland, Metro, Multnomah County, Oregon, 97209, United States
PORTLAND, OR 972093609
Phone: (503) 294-1681
Fax: (503) 241-7419
Type: Mailing
Emerge, 412, Southwest 12th Avenue, University District, Portland Downtown, Portland, Metro, Multnomah County, Oregon, 97205, United States
PORTLAND, OR 972052329
Phone: (503) 228-7134
Fax: (503) 445-0749
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
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Educational use only—not medical, billing, or legal advice.
No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
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No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 97209)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | OR | |
| - | OR | |
| - | OR | |
| Clinical Social Worker | OR | |
| Internal Medicine | CA | |
| Nurse Practitioner | AZ | |
| Nurse Practitioner | OR | |
| - | OR | |
| Nurse Practitioner | OR | |
| Mental Health Counselor | OR |
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