Individual
KEVIN DAVID MICHAEL MENASCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.C.S.W.
Contact information
Practice address
32 NE 11TH AVE, PORTLAND, OR 97232
(978) 979-6094
Mailing address
32 NE 11TH AVE, PORTLAND, OR 97232
(978) 979-6094
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
L9518
OR
Other
Enumeration date
05/30/2013
Last updated
03/09/2022
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