Provider Demographics
NPI:1669534384
Name:ALTER, MICHAEL AHARON (LCSW)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:AHARON
Last Name:ALTER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10373 NE HANCOCK ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-3873
Mailing Address - Country:US
Mailing Address - Phone:503-819-9861
Mailing Address - Fax:503-282-1270
Practice Address - Street 1:10373 NE HANCOCK ST
Practice Address - Street 2:SUITE 220
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-3873
Practice Address - Country:US
Practice Address - Phone:503-819-9861
Practice Address - Fax:503-282-1270
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0022011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical