Individual
CARLA Y CANSECO-MACA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
209 SW 4TH AVE STE 520, PORTLAND, OR 97204-1825
(971) 806-7062
(503) 988-4386
Mailing address
209 SW 4TH AVE STE 520, PORTLAND, OR 97204-1825
(503) 988-5464
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/05/2021
Last updated
12/10/2024
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