Active NPI
Timothy Steven Irmen, LCSW
- Clinical Social Worker
- Newberg, OR
National Provider Identifier
1033633813
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- L3878
- Practice address
- 710 E Foothills Dr Ste 104C
Newberg, OR 97132-6125 - Phone
- (503) 930-2923
- Fax
- (503) 523-2193
- NPI assigned
- Aug 2, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | L3878 | OR | Primary |
Addresses
Primary practice location
710 E Foothills Dr Ste 104C
Newberg, OR 97132-6125
Mailing address
710C Foothills Dr. SE
Suite 104
Newberg, OR 97132
Phone (503) 930-2923
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| L3878 | Other | OR | OREGON BOARD OF SOCIAL WORK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L3878 | OR | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1501632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1033633813",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "710C FOOTHILLS DR. SE",
"address_2": "SUITE 104",
"city": "NEWBERG",
"state": "OR",
"postal_code": "97132",
"telephone_number": "503-930-2923",
"fax_number": "503-523-2193"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "710 E FOOTHILLS DR STE 104C",
"city": "NEWBERG",
"state": "OR",
"postal_code": "971326125",
"telephone_number": "503-930-2923",
"fax_number": "503-523-2193"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IRMEN",
"first_name": "TIMOTHY",
"middle_name": "STEVEN",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-08-02",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OR",
"license": "L3878",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OREGON BOARD OF SOCIAL WORK",
"identifier": "L3878",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Newberg, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.