Provider Demographics
NPI:1003373101
Name:FADRIQUELA, CARLA E (LCSW)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:E
Last Name:FADRIQUELA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:E
Other - Last Name:MCGUIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2980 SW 123RD AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-1325
Mailing Address - Country:US
Mailing Address - Phone:808-281-4616
Mailing Address - Fax:
Practice Address - Street 1:2980 SW 123RD AVE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-1325
Practice Address - Country:US
Practice Address - Phone:808-281-4616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-43281041C0700X
ORL78611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical