Provider Demographics
NPI:1578905964
Name:IRVING, CARMEL THERESE (MSW,LCSW)
Entity Type:Individual
Prefix:MISS
First Name:CARMEL
Middle Name:THERESE
Last Name:IRVING
Suffix:
Gender:F
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5912 NE 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-4951
Mailing Address - Country:US
Mailing Address - Phone:503-312-3123
Mailing Address - Fax:
Practice Address - Street 1:5912 NE 16TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211
Practice Address - Country:US
Practice Address - Phone:503-312-3123
Practice Address - Fax:971-244-8981
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-25
Last Update Date:2018-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR46791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical