Provider Demographics
NPI:1447692090
Name:DORN, CARLOTA DE LOS MILAGROS (MSW)
Entity type:Individual
Prefix:
First Name:CARLOTA
Middle Name:DE LOS MILAGROS
Last Name:DORN
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 1:211 E 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2773
Mailing Address - Country:US
Mailing Address - Phone:541-242-0473
Mailing Address - Fax:
Practice Address - Street 1:211 E 7TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2773
Practice Address - Country:US
Practice Address - Phone:541-242-0473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW738401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical