Provider Demographics
NPI:1740680909
Name:NIEDENTHAL DURET, EDOUARD
Entity type:Individual
Prefix:
First Name:EDOUARD
Middle Name:
Last Name:NIEDENTHAL DURET
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5441 S MACADAM AVE STE N
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-6106
Mailing Address - Country:US
Mailing Address - Phone:971-433-2978
Mailing Address - Fax:458-216-8051
Practice Address - Street 1:5441 S MACADAM AVE STE N
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-6106
Practice Address - Country:US
Practice Address - Phone:971-433-2978
Practice Address - Fax:458-216-8051
Is Sole Proprietor?:No
Enumeration Date:2014-08-25
Last Update Date:2025-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1178851041C0700X
372600000X
ORL111171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No372600000XNursing Service Related ProvidersAdult Companion