Individual
MYRA BAZELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
820 NW 12TH AVE APT 606, PORTLAND, OR 97209-3052
(215) 917-3367
Mailing address
820 NW 12TH AVE APT 606, PORTLAND, OR 97209-3052
(215) 917-3367
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
CSW005321
GA
1041C0700X
Clinical Social Worker
Primary
L8297
OR
Other
Enumeration date
08/03/2012
Last updated
05/02/2020
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