Individual
MS. MARY E. IANNUCCILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
2250 NW FLANDERS ST, SUITE 103, PORTLAND, OR 97210-3443
(503) 796-9242
(503) 657-8310
Mailing address
2250 NW FLANDERS ST, SUITE 103, PORTLAND, OR 97210-3443
(503) 796-9242
(503) 657-8310
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0759
OR
Other
Enumeration date
04/10/2007
Last updated
07/08/2007
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