Provider Demographics
NPI:1386992402
Name:VIOLA, ELIZABETH HANNA (LCSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:HANNA
Last Name:VIOLA
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 18016
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97218-0016
Mailing Address - Country:US
Mailing Address - Phone:360-936-1731
Mailing Address - Fax:503-972-1869
Practice Address - Street 1:2328 NE FREMONT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-2453
Practice Address - Country:US
Practice Address - Phone:360-936-1731
Practice Address - Fax:503-972-1869
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL54201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical