Active NPI
Patrice Marie Stamos, LCSW
- Clinical Social Worker
- Eugene, OR
National Provider Identifier
1306178595
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- L12651
- Practice address
- 66 Club Rd Ste 160
Eugene, OR 97401-2439 - Phone
- (541) 345-1722
- Fax
- (541) 485-7049
- NPI assigned
- Feb 12, 2010
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149.015677 | IL | |
| Clinical Social Worker | 1041C0700X | 103382 | CA | |
| Clinical Social Worker | 1041C0700X | L12651 | OR | Primary |
Addresses
Primary practice location
66 Club Rd Ste 160
Eugene, OR 97401-2439
Mailing address
PO Box 70779
Springfield, OR 97475-0137
Phone (541) 345-1722
Other practice location 1
1515 Em Ray Dr
Eugene, OR 97405-1921
Phone (212) 621-6536
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12166327 | Other | CAQH ID | |
| 500799653 | Medicaid | OR |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 103382 | CA | MD | Clinical Social Worker |
| 149.015677 | IL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1265932800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678752000000",
"number": "1306178595",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 70779",
"city": "SPRINGFIELD",
"state": "OR",
"postal_code": "974750137",
"telephone_number": "541-345-1722",
"fax_number": "541-485-7049"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "66 CLUB RD STE 160",
"city": "EUGENE",
"state": "OR",
"postal_code": "974012439",
"telephone_number": "541-345-1722",
"fax_number": "541-485-7049"
}
],
"practiceLocations": [
{
"address_1": "1515 Em Ray Dr",
"address_purpose": "LOCATION",
"city": "Eugene",
"state": "OR",
"postal_code": "974051921",
"country_code": "US",
"telephone_number": "212-621-6536",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "STAMOS",
"first_name": "PATRICE",
"middle_name": "MARIE",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-02-12",
"last_updated": "2023-03-14",
"certification_date": "2023-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149.015677",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "103382",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OR",
"license": "L12651",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH ID",
"identifier": "12166327",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500799653",
"state": "OR"
}
],
"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 Mar 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.