Individual provider Active NPI

Glykeria Manis, LCSW

  • Clinical Social Worker
  • Portland, OR
National Provider Identifier
1003194366
Registry record updated Nov 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
L7439 Issued in OR
Practice address
9135 SW Barnes Rd
Portland, OR 97225-6646
Phone
(503) 216-1234
NPI assigned
Aug 3, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X L7439 OR Primary

Addresses

Primary practice location

9135 SW Barnes Rd
Portland, OR 97225-6646

Mailing address

PO Box 3396
Portland, OR 97208-3396
Phone (503) 216-2380

Other practice location 1

9155 SW Barnes Rd Ste 205
Portland, OR 97225-6629
Phone (503) 216-2025

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231107002084 OR Practitioner - Clinical Social Worker 9234586652 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mindful Therapy Group PCGroup PAC ID 4981872561, 654 clinicians

Practice addresses (Care Compare)

11740 SW 68TH Pkwy
Suite 200
Tigard, OR 97223-9058
Phone (971) 352-6984

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
L7439ORMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Mindful Therapy Group PC Clinical CurrentSince Jan 30, 2025 Accepting new patients
Providence Health & Services - Oregon CurrentSince Sep 24, 2023 Accepting new patients
Providence Health & Services - Oregon Current Accepting new patients

Locations

9205 SW Barnes Rd
Portland, OR 97225
Phone (503) 216-1234

5440 SW Westgate Dr
Ste 350
Portland, OR 97221
Phone (503) 292-1100

9155 SW Barnes Rd
Ste 205
Portland, OR 97225
Phone (503) 216-2025

9135 SW Barnes Rd
Portland, OR 97225
Phone (503) 216-1234

11740 SW 68th Pkwy
Ste 200
Tigard, OR 97223
Phone (425) 477-4216

6505 216th St SW
Ste 100
Mountlake Terrace, WA 98043
Phone (425) 678-6463

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1312329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698883200000",
    "number": "1003194366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3396",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083396",
            "telephone_number": "503-216-2380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9135 SW BARNES RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972256646",
            "telephone_number": "503-216-1234"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9155 SW Barnes Rd Ste 205",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972256629",
            "country_code": "US",
            "telephone_number": "503-216-2025",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANIS",
        "first_name": "GLYKERIA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-03",
        "last_updated": "2023-11-02",
        "certification_date": "2023-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L7439",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.