Provider Demographics
NPI:1215904370
Name:EMMETT, ANNE DOLORES (LCSW)
Entity type:Individual
Prefix:MS
First Name:ANNE
Middle Name:DOLORES
Last Name:EMMETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11860
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-0860
Mailing Address - Country:US
Mailing Address - Phone:503-238-2405
Mailing Address - Fax:888-974-3958
Practice Address - Street 1:1020 SW TAYLOR ST STE 560
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2533
Practice Address - Country:US
Practice Address - Phone:503-238-2405
Practice Address - Fax:888-974-3958
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2022-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL12401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR96447Medicare UPIN
OR114420Medicare ID - Type Unspecified