Individual
MS. MARY ROBINETTE H FITZSIMMONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
2701 NW VAUGHN ST, STE 140, PORTLAND, OR 97210-5311
(503) 499-5200
(877) 477-2329
Mailing address
2701 NW VAUGHN ST, STE 140, PORTLAND, OR 97210-5311
(503) 499-5200
(877) 477-2329
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L4244
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CG60145984
WASHINGTON STATE DEPARTMENT OF HEALTH
WA
01
—
L4244
OREGON STATE BOARD OF LICENSED SOCIAL WORKERS
OR
Enumeration date
03/01/2012
Last updated
03/01/2012
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