Provider Demographics
NPI:1629374137
Name:PANZA, JOSEPH PAUL (MA, LPC, CADC II)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:PAUL
Last Name:PANZA
Suffix:
Gender:M
Credentials:MA, LPC, CADC II
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:
Other - Last Name:PANZA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC, CADC II, SA
Mailing Address - Street 1:7817 SW ELMWOOD ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-9063
Mailing Address - Country:US
Mailing Address - Phone:503-333-2037
Mailing Address - Fax:971-255-0631
Practice Address - Street 1:7817 SW ELMWOOD ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-9063
Practice Address - Country:US
Practice Address - Phone:503-333-2037
Practice Address - Fax:971-255-0631
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-31
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2358101YP2500X
OR06-R-22101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)