Provider Demographics
NPI:1235110248
Name:MATHEWS, SABRINA ULLMANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SABRINA
Middle Name:ULLMANN
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 SW WASHINGTON ST
Mailing Address - Street 2:STE. 1015
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-2635
Mailing Address - Country:US
Mailing Address - Phone:503-297-1998
Mailing Address - Fax:
Practice Address - Street 1:319 SW WASHINGTON ST
Practice Address - Street 2:SUITE 1015
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-2635
Practice Address - Country:US
Practice Address - Phone:503-297-1998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR130687Medicare ID - Type Unspecified
ORQ37105Medicare UPIN