Individual provider Active NPI

Christina J Mullin, LCSW

  • Clinical Social Worker
  • Portland, OR
National Provider Identifier
1265153126
Registry record updated Jul 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
10808 Issued in OR
Practice address
1130 SW Morrison St Ste 328
Portland, OR 97205-2214
Phone
(503) 479-5636
Fax
(855) 918-3577
NPI assigned
Sep 8, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 18, 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 10808 OR Primary

Addresses

Primary practice location

1130 SW Morrison St Ste 328
Portland, OR 97205-2214

Mailing address

4207 SE Woodstock Blvd # 138
Portland, OR 97206-6267
Phone (503) 479-5636

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
I20250211003287 OR Practitioner - Clinical Social Worker 1456881093 Practice locations: Portland, OR

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1130 SW Morrison St
Suite 328
Portland, OR 97205-2214
Phone (503) 479-5636

4207 SE Woodstock Blvd
Suite 138
Portland, OR 97206-6267

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10808ORMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Aligned Intent LLC Clinical CurrentSince Jun 1, 2023 Accepting new patients

Locations

4207 SE Woodstock Blvd
Portland, OR 97206
Phone (503) 312-6005

1130 SW Morrison St
Ste 328
Portland, OR 97205
Phone (503) 479-5636

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.

NPI Registry JSON

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

{
    "created_epoch": "1662595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689638400000",
    "number": "1265153126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4207 SE WOODSTOCK BLVD # 138",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972066267",
            "telephone_number": "503-479-5636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 SW MORRISON ST STE 328",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972052214",
            "telephone_number": "503-479-5636",
            "fax_number": "855-918-3577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLIN",
        "first_name": "CHRISTINA",
        "middle_name": "J",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-08",
        "last_updated": "2023-07-18",
        "certification_date": "2023-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "10808",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.