Provider Demographics
NPI:1285049031
Name:BARDOSSI, JANETB (LCSW)
Entity type:Individual
Prefix:MS
First Name:JANETB
Middle Name:
Last Name:BARDOSSI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JANET
Other - Middle Name:
Other - Last Name:BARDOSSI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:7528 SE 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-8312
Mailing Address - Country:US
Mailing Address - Phone:503-380-1730
Mailing Address - Fax:
Practice Address - Street 1:7528 SE 34TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-8312
Practice Address - Country:US
Practice Address - Phone:503-380-1730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical