Provider Demographics
NPI:1144947417
Name:GORMAN, VICTORIA N (LCSW, LICSW)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:N
Last Name:GORMAN
Suffix:
Gender:F
Credentials:LCSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2275 NW SAVIER ST APT 203
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3913
Mailing Address - Country:US
Mailing Address - Phone:651-380-3519
Mailing Address - Fax:
Practice Address - Street 1:319 SW WASHINGTON ST STE 1001
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-2615
Practice Address - Country:US
Practice Address - Phone:971-202-0677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-26
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN30150104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker