Individual
BRIAN BRACELIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
2332 SE 52ND AVE, PORTLAND, OR 97215-3912
(503) 878-9741
Mailing address
2332 SE 52ND AVE, PORTLAND, OR 97215-3912
(503) 878-9741
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L11188
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500776222
—
OR
Enumeration date
02/04/2020
Last updated
11/09/2023
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