Individual
DOUGLAS BANASKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW, LCSW
Contact information
Practice address
10180 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-8970
(503) 652-2880
Mailing address
5200 SE 132ND AVE APT 5, PORTLAND, OR 97236-4186
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L2928
OR
Other
Enumeration date
12/04/2017
Last updated
12/04/2017
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