Active NPI
Andrea E Mittleider, LCSW
- Clinical Social Worker
- Eugene, OR
National Provider Identifier
1063576155
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- L4955
- Practice address
- 1200 Hilyard St Ste 230
Eugene, OR 97401-8122 - Phone
- (458) 205-6011
- Fax
- (458) 205-6071
- NPI assigned
- Dec 21, 2006
- Sex
- Female
- Sole proprietor
- No
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 | L4955 | OR | Primary |
Addresses
Primary practice location
1200 Hilyard St Ste 230
Eugene, OR 97401-8122
Mailing address
1115 SE 164TH Ave Dept 358
Vancouver, WA 98683-8004
Phone (360) 729-1462
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)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Peacehealth | Past | Accepting new patients |
Networks
- WA PPO C-SNP
- devoted network organization-83621310-88c0-4660-8f8d-b8ea8f4dc04e
Organizations & group practices 1
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.
-
- Multi-Specialty Clinic/Center
- Longview, WA
- NPI 1720056187
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166659200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1541980800000",
"number": "1063576155",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1115 SE 164TH AVE DEPT 358",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986838004",
"telephone_number": "360-729-1462",
"fax_number": "360-729-3104"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 HILYARD ST STE 230",
"city": "EUGENE",
"state": "OR",
"postal_code": "974018122",
"telephone_number": "458-205-6011",
"fax_number": "458-205-6071"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITTLEIDER",
"first_name": "ANDREA",
"middle_name": "E",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-21",
"last_updated": "2018-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OR",
"license": "L4955",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eugene, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.