Provider Demographics
NPI:1336755784
Name:MARVIN, JOHN S (MSW, CSWA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:MARVIN
Suffix:
Gender:M
Credentials:MSW, CSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 NE ALBERTA ST., STE 200
Mailing Address - Street 2:C/O COBALT P.C.
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211
Mailing Address - Country:US
Mailing Address - Phone:503-597-8237
Mailing Address - Fax:
Practice Address - Street 1:2450 SE BELMONT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2821
Practice Address - Country:US
Practice Address - Phone:971-910-8918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health