Provider Demographics
NPI:1851518344
Name:MARKOVICS, CAROL B (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:B
Last Name:MARKOVICS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8050 SW WARM SPRINGS ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-7424
Mailing Address - Country:US
Mailing Address - Phone:503-563-5280
Mailing Address - Fax:
Practice Address - Street 1:8050 SW WARM SPRINGS ST
Practice Address - Street 2:SUITE 130
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-7424
Practice Address - Country:US
Practice Address - Phone:503-563-5280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2017-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005058103T00000X
OR1948103T00000X, 103TC0700X, 103TC2200X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10996BMedicare PIN