Provider Demographics
NPI:1790485282
Name:MACIAS, DONNA (BA)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:MACIAS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 SW VALERIA VIEW DR APT 106
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-7071
Mailing Address - Country:US
Mailing Address - Phone:626-491-5700
Mailing Address - Fax:
Practice Address - Street 1:5100 S MACADAM AVE STE 400
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3854
Practice Address - Country:US
Practice Address - Phone:503-244-5211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker