Active NPI
Roxanne Mossman, LCSW LICENSED CLINIC
- Clinical Social Worker
- Portland, OR
National Provider Identifier
1730231275
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCSW 1792
- Practice address
- 1211 NW Glisan St
Suite 205
Portland, OR 97209 - Phone
- (503) 225-1177
- NPI assigned
- Jan 17, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCSW 1792 | OR | Primary |
Addresses
Primary practice location
1211 NW Glisan St
Suite 205
Portland, OR 97209
Mailing address
PO Box 3573
Portland, OR 97208-3573
Phone (503) 225-1177
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20071221000518 | OR | Practitioner - Clinical Social Worker | 2062502453 | Practice locations: Portland, OR |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCSW 1792 | OR | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168992000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1730231275",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3573",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972083573",
"telephone_number": "503-225-1177"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1211 NW GLISAN ST",
"address_2": "SUITE 205",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97209",
"telephone_number": "503-225-1177"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOSSMAN",
"first_name": "ROXANNE",
"name_prefix": "Dr.",
"credential": "LCSW LICENSED CLINIC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OR",
"license": "LCSW 1792",
"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; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.