Active NPI
Diane Havnen-Smith, MSW, LCSW
- Clinical Social Worker
- Portland, OR
National Provider Identifier
1558513846
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 2727
- Practice address
- 4410 SE Woodstock Blvd Ste 230
Portland, OR 97206-6206 - Phone
- (503) 314-6349
- NPI assigned
- Oct 17, 2008
- Sex
- Female
- 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 | 2727 | OR | Primary |
Addresses
Primary practice location
4410 SE Woodstock Blvd Ste 230
Portland, OR 97206-6206
Mailing address
4410 SE Woodstock Blvd Ste 230
Portland, OR 97206-6206
Phone (503) 314-6349
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 |
|---|---|---|---|
| 2727 | OR | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1224201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1634342400000",
"number": "1558513846",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4410 SE WOODSTOCK BLVD STE 230",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972066206",
"telephone_number": "503-314-6349"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4410 SE WOODSTOCK BLVD STE 230",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972066206",
"telephone_number": "503-314-6349"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAVNEN-SMITH",
"first_name": "DIANE",
"name_prefix": "Ms.",
"credential": "MSW, LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-10-17",
"last_updated": "2021-10-16",
"certification_date": "2021-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OR",
"license": "2727",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.