Provider Demographics
NPI:1871574558
Name:MANFIELD, DAVID C (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:MANFIELD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2063 CREST DR
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-2717
Mailing Address - Country:US
Mailing Address - Phone:503-223-2391
Mailing Address - Fax:
Practice Address - Street 1:1962 NW KEARNEY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1464
Practice Address - Country:US
Practice Address - Phone:503-223-2391
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0773103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OROOOOTCHGDMedicare ID - Type Unspecified