Provider Demographics
NPI:1598803728
Name:HELLER, LAURA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:HELLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10373 NE HANCOCK ST STE 200
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-3873
Mailing Address - Country:US
Mailing Address - Phone:503-261-6178
Mailing Address - Fax:
Practice Address - Street 1:10373 NE HANCOCK ST STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-3873
Practice Address - Country:US
Practice Address - Phone:503-261-6178
Practice Address - Fax:503-261-6393
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL23741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical