Provider Demographics
NPI:1538150636
Name:ARON, MARK (PSYD, MSW, PC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:ARON
Suffix:
Gender:M
Credentials:PSYD, MSW, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 NW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-4812
Mailing Address - Country:US
Mailing Address - Phone:541-754-9072
Mailing Address - Fax:541-754-0477
Practice Address - Street 1:216 NW 6TH ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-4812
Practice Address - Country:US
Practice Address - Phone:541-754-9072
Practice Address - Fax:541-754-0477
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1097103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR106959Medicare ID - Type Unspecified