Provider Demographics
NPI:1336413533
Name:AZAROW, KATHERINE ELEANOR (LCSW, QMHP, CADC I)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:ELEANOR
Last Name:AZAROW
Suffix:
Gender:F
Credentials:LCSW, QMHP, CADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1427 SE 182ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-5008
Mailing Address - Country:US
Mailing Address - Phone:503-761-6005
Mailing Address - Fax:503-761-1434
Practice Address - Street 1:1427 SE 182ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-5008
Practice Address - Country:US
Practice Address - Phone:503-761-6005
Practice Address - Fax:503-761-1434
Is Sole Proprietor?:No
Enumeration Date:2012-03-06
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR63481041C0700X
OR14-R-37101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)