Provider Demographics
NPI:1811034309
Name:MATTOSO, MARCIA SOUZA (MA, MFT, NCGCII)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:SOUZA
Last Name:MATTOSO
Suffix:
Gender:F
Credentials:MA, MFT, NCGCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17059 SW RIVENDELL DR.
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7624
Mailing Address - Country:US
Mailing Address - Phone:503-639-5583
Mailing Address - Fax:
Practice Address - Street 1:2415 SE 43RD.
Practice Address - Street 2:SUITE 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206
Practice Address - Country:US
Practice Address - Phone:503-872-0164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)