Provider Demographics
NPI:1043429947
Name:SEFEROVICH, MAUREEN GAYLE (MSW)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:GAYLE
Last Name:SEFEROVICH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2238 NE 13TH AVE
Mailing Address - Street 2:#37
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-4320
Mailing Address - Country:US
Mailing Address - Phone:785-979-3221
Mailing Address - Fax:
Practice Address - Street 1:14513 SE STARK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-2155
Practice Address - Country:US
Practice Address - Phone:503-328-0435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health