Provider Demographics
NPI:1174864102
Name:CORMIER CASTANEDA, MEGAN CHRISTINE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:CHRISTINE
Last Name:CORMIER CASTANEDA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:14535 WESTLAKE DR STE C
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-7775
Mailing Address - Country:US
Mailing Address - Phone:503-832-4857
Mailing Address - Fax:503-386-3413
Practice Address - Street 1:7340 SW HUNZIKER RD STE 210
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-2304
Practice Address - Country:US
Practice Address - Phone:503-352-0036
Practice Address - Fax:503-352-0040
Is Sole Proprietor?:No
Enumeration Date:2013-03-15
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OR3277103T00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health