Provider Demographics
NPI:1104251362
Name:MAYO, NAOMI VICTORIA (LCSW, PHD)
Entity type:Individual
Prefix:DR
First Name:NAOMI
Middle Name:VICTORIA
Last Name:MAYO
Suffix:
Gender:F
Credentials:LCSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:849 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-1956
Mailing Address - Country:US
Mailing Address - Phone:541-645-5050
Mailing Address - Fax:
Practice Address - Street 1:849 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031
Practice Address - Country:US
Practice Address - Phone:541-645-5050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-06
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL68581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical