Provider Demographics
NPI:1992107403
Name:OZER, HERBERT GLENN (LCSW)
Entity type:Individual
Prefix:
First Name:HERBERT
Middle Name:GLENN
Last Name:OZER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1631 NE BROADWAY ST
Mailing Address - Street 2:PMB 219
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1425
Mailing Address - Country:US
Mailing Address - Phone:503-307-3599
Mailing Address - Fax:971-251-1108
Practice Address - Street 1:1631 NE BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1425
Practice Address - Country:US
Practice Address - Phone:503-307-3599
Practice Address - Fax:503-287-5710
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical