Basic Information
| Provider Information | |||||||||
| NPI: | 1063794261 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PACTANAC | ||||||||
| FirstName: | MARGO | ||||||||
| MiddleName: | COHN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | COHN | ||||||||
| OtherFirstName: | MARGO | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 82819 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972820819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032335405 | ||||||||
| FaxNumber: | 5032332692 | ||||||||
| Practice Location | |||||||||
| Address1: | 1815 SW MARLOW AVE | ||||||||
| Address2: | SUITE 218 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972255185 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032335405 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2011 | ||||||||
| LastUpdateDate: | 01/07/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | L6324 | OR | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101Y00000X | L6324 | OR | N | Behavioral Health & Social Service Providers | Counselor | 101YM0800X | L6324 | OR | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.