Individual
MAIA ANTOINETTE BELLAVIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1500 NE IRVING ST, PORTLAND, OR 97232-2243
(971) 352-6971
Mailing address
5405 NE 41ST AVE, PORTLAND, OR 97211-8044
(503) 383-1769
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
A14732
OR
1041C0700X
Clinical Social Worker
Primary
L17624
OR
Other
Enumeration date
01/27/2022
Last updated
01/28/2026
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