Active NPI
David Ebaugh, LCSW
- Clinical Social Worker
- Portland, OR
National Provider Identifier
1619015153
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- L003678
- Practice address
- 2303 E Burnside St
Portland, OR 97214-1655 - Phone
- (503) 245-3370
- NPI assigned
- Feb 4, 2007
- Last updated
- Jul 8, 2007
- 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 | L003678 | OR | Primary |
Addresses
Primary practice location
2303 E Burnside St
Portland, OR 97214-1655
Mailing address
6315 N Campbell Ave
Portland, OR 97217-4914
Phone (503) 345-3370
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective May 14, 2020 through May 14, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L003678 | OR | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170547200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1619015153",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6315 N CAMPBELL AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972174914",
"telephone_number": "503-345-3370"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2303 E BURNSIDE ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972141655",
"telephone_number": "503-245-3370"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EBAUGH",
"first_name": "DAVID",
"name_prefix": "Mr.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OR",
"license": "L003678",
"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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.