Provider Demographics
NPI:1073238945
Name:STERN, EMMA (MA, PCA R7893)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:STERN
Suffix:
Gender:F
Credentials:MA, PCA R7893
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 220355
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97269-0355
Mailing Address - Country:US
Mailing Address - Phone:510-730-1789
Mailing Address - Fax:
Practice Address - Street 1:10110 SE WAVERLY CT APT 14
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-3412
Practice Address - Country:US
Practice Address - Phone:510-730-1789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR7893101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health