Individual
CARLA E FADRIQUELA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2980 SW 123RD AVE, BEAVERTON, OR 97005-1325
(808) 281-4616
Mailing address
2980 SW 123RD AVE, BEAVERTON, OR 97005-1325
(808) 281-4616
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L7861
OR
1041C0700X
Clinical Social Worker
LCSW-4328
HI
Other
Enumeration date
02/25/2019
Last updated
02/25/2019
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