Provider Demographics
NPI:1639187750
Name:OZIEL, LAUREL DIANE (MSW,LCSW,QMHP)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:DIANE
Last Name:OZIEL
Suffix:
Gender:F
Credentials:MSW,LCSW,QMHP
Other - Prefix:
Other - First Name:LAUREL
Other - Middle Name:DIANE
Other - Last Name:PUZISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:720 SW WASHINGTON ST
Mailing Address - Street 2:SUITE 628
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-3519
Mailing Address - Country:US
Mailing Address - Phone:503-421-0471
Mailing Address - Fax:503-954-3254
Practice Address - Street 1:720 SW WASHINGTON ST
Practice Address - Street 2:SUITE 628
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-3519
Practice Address - Country:US
Practice Address - Phone:503-421-0471
Practice Address - Fax:503-954-3254
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORL31691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
118773Medicare ID - Type Unspecified
Q13312Medicare UPIN