Provider Demographics
NPI:1235912742
Name:MAYA, MICHELLE (MSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MAYA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 NW 6TH AVE FL 5
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3991
Mailing Address - Country:US
Mailing Address - Phone:503-988-4753
Mailing Address - Fax:503-988-3015
Practice Address - Street 1:3505 SE 182ND AVE
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-5028
Practice Address - Country:US
Practice Address - Phone:503-988-5488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-17
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker