Basic Information
| Provider Information | |||||||||
| NPI: | 1558461483 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALTMAN | ||||||||
| FirstName: | MAYBELLE | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14255 SW BRIGADOON CT | ||||||||
| Address2: | |||||||||
| City: | BEAVERTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970053369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036411475 | ||||||||
| FaxNumber: | 5036418548 | ||||||||
| Practice Location | |||||||||
| Address1: | 14255 SW BRIGADOON CT | ||||||||
| Address2: | |||||||||
| City: | BEAVERTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970053369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036411475 | ||||||||
| FaxNumber: | 5036418548 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 2979 | OR | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.