Individual provider Active NPI

Stacy L Mandzij, LCSW

  • Clinical Social Worker
  • Portland, OR
National Provider Identifier
1659890887
Registry record updated Mar 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
L8570 Issued in OR
Practice address
1310 SW 17TH Ave
Portland, OR 97201-2522
Phone
(503) 231-2641
Fax
(503) 467-4077
NPI assigned
Sep 19, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2026

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 L8570 OR Primary

Addresses

Primary practice location

1310 SW 17TH Ave
Portland, OR 97201-2522

Mailing address

1776 SW Madison St
Portland, OR 97205-1715
Phone (971) 386-2278

Other identifiers 1

IdentifierTypeStateIssuer
500734958MedicaidOR

Other names 1

  • Stacia L Mandzij Other name

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
I20201001000272 OR Practitioner - Clinical Social Worker 9133548720 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Western Psychological and Counseling Services LLCGroup PAC ID 7719975085, 331 clinicians

Practice addresses (Care Compare)

2222 E Powell Blvd
Gresham, OR 97080-1365
Phone (503) 669-4300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
L8570ORMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Western Psychological and Counseling Services LLC Mental Health CurrentSince Sep 2, 2020 Accepting new patients
Western Psychological and Counseling Services LLC Mental Health CurrentSince Sep 2, 2020 Accepting new patients

Locations

880 82nd Dr
Gladstone, OR 97027
Phone (503) 626-9494

1700 NW Civic Dr
Ste 310
Gresham, OR 97030
Phone (503) 666-8832

2222 E Powell Blvd
Gresham, OR 97080
Phone (503) 669-4300

Interoperability endpoints

  • Direct secure messaging: lifestancehealth.staciamandzij@148835.advancedmd-direct.com

Organizations & group practices 2

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": "1505779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773360000000",
    "number": "1659890887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1776 SW MADISON ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972051715",
            "telephone_number": "971-386-2278",
            "fax_number": "503-224-4494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 SW 17TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972012522",
            "telephone_number": "503-231-2641",
            "fax_number": "503-467-4077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANDZIJ",
        "first_name": "STACY",
        "middle_name": "L",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-19",
        "last_updated": "2026-03-13",
        "certification_date": "2026-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L8570",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500734958",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACIA",
            "last_name": "MANDZIJ",
            "middle_name": "L",
            "credential": "LCSW",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.