Provider Demographics
NPI:1255720181
Name:FORSTER, AVIEL
Entity type:Individual
Prefix:
First Name:AVIEL
Middle Name:
Last Name:FORSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 SW OAK ST
Mailing Address - Street 2:STE. 210
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-1817
Mailing Address - Country:US
Mailing Address - Phone:503-988-7468
Mailing Address - Fax:503-988-3015
Practice Address - Street 1:426 SW STARK ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-2303
Practice Address - Country:US
Practice Address - Phone:503-988-5020
Practice Address - Fax:503-988-6899
Is Sole Proprietor?:No
Enumeration Date:2015-01-15
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA3185104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR096511Medicaid
ORR0000WCJHTMedicare Oscar/Certification
OR381925Medicare Oscar/Certification