Provider Demographics
NPI:1154483824
Name:MAIER, ABBY LOTTRIDGE (LCSW RN)
Entity Type:Individual
Prefix:MS
First Name:ABBY
Middle Name:LOTTRIDGE
Last Name:MAIER
Suffix:
Gender:F
Credentials:LCSW RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 SW WASHINGTON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-3222
Mailing Address - Country:US
Mailing Address - Phone:503-228-8569
Mailing Address - Fax:503-241-8346
Practice Address - Street 1:812 SW WASHINGTON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-3222
Practice Address - Country:US
Practice Address - Phone:503-228-8569
Practice Address - Fax:503-241-8346
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLCSW #3311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0000TLBJVMedicare PIN