Organization · Type 2 NPI

Diverge

Clinical Social Worker · Portland, OR

NPI number 1053288431 Active

Practice location

555 SE Mlk Blvd
Portland, OR 97214-2526

Mailing address

2000 NE 42nd Ave
Portland, OR 97213-1399

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor 101YM0800XNone listed
Clinical Social Worker Primary 1041C0700XNone listed
Peer Specialist 175T00000XNone listed

Clinical Social Worker: A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpers…

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About NPI 1053288431

Diverge's National Provider Identifier is 1053288431, issued on Oct 21, 2025. The primary taxonomy on file is Clinical Social Worker (1041C0700X), and the practice location is in Portland, OR. The record was last updated on Oct 21, 2025.