David Ebaugh, LCSW
Individual provider Active NPI Clinical Social Worker · Portland, OR
NPI 1619015153 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1619015153
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- L003678 (OR)
- Practice address
- 2303 E Burnside St
Portland, OR 97214-1655 - Phone
- (503) 245-3370
- NPI assigned
- Feb 4, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- 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
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L003678 | OR | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | L003678 | OR | Yes |
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
Other providers in Portland, OR
- Austin Charles Eaton
- Dennis Herman Eaton
- Joseph Jordan Eaton II
- Sonja Lea Eaton
- Michele Eave
- Ebensteiner Chiropractic LLC
- Paul Ebensteiner
- Joy Elizabeth Eberhardt de Master
- Lucas Eberhardt de Master
- Alice Eberharter
All providers in Portland, OR · Clinical Social Worker in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.