Provider Demographics
NPI:1396822995
Name:DRISCOLL, WILLIAM JOSEPH (LCSW)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:DRISCOLL
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 1:36 SW NYE ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-3821
Mailing Address - Country:US
Mailing Address - Phone:541-265-0513
Mailing Address - Fax:541-867-6548
Practice Address - Street 1:4909 S COAST HWY
Practice Address - Street 2:
Practice Address - City:SOUTH BEACH
Practice Address - State:OR
Practice Address - Zip Code:97366-9616
Practice Address - Country:US
Practice Address - Phone:541-574-5960
Practice Address - Fax:541-867-6548
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1189-1231041C0700X
ORL45791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR213144Medicaid
ORR100449Medicare PIN
OR213144Medicaid