Provider Demographics
NPI:1083337257
Name:SHOEMAKER, JAMES SAMUEL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:SAMUEL
Last Name:SHOEMAKER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1544 SE HAWTHORNE BLVD APT 3
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-3976
Mailing Address - Country:US
Mailing Address - Phone:616-822-1637
Mailing Address - Fax:
Practice Address - Street 1:1130 NW 22ND AVE STE 220
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2969
Practice Address - Country:US
Practice Address - Phone:503-413-8988
Practice Address - Fax:503-413-5629
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL124121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical