Provider Demographics
NPI:1669864054
Name:MENOLASINO, MARIA (MS, CRC)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:MENOLASINO
Suffix:
Gender:F
Credentials:MS, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 SE SALMON ST
Mailing Address - Street 2:SUITE L3
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-3628
Mailing Address - Country:US
Mailing Address - Phone:503-913-2704
Mailing Address - Fax:
Practice Address - Street 1:1135 SE SALMON ST
Practice Address - Street 2:SUITE L3
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-3628
Practice Address - Country:US
Practice Address - Phone:503-913-2704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor