Provider Demographics
NPI:1659256592
Name:GIOSSO, CHRISTINA EDA
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:EDA
Last Name:GIOSSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 SW 10TH AVE APT 322
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-3232
Mailing Address - Country:US
Mailing Address - Phone:831-440-6123
Mailing Address - Fax:
Practice Address - Street 1:4110 NE 122ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-1300
Practice Address - Country:US
Practice Address - Phone:971-500-2889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program