Provider Demographics
NPI:1255475489
Name:SIBILLA, BRYNNA LEVIN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BRYNNA
Middle Name:LEVIN
Last Name:SIBILLA
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 1:1934 NE BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1502
Mailing Address - Country:US
Mailing Address - Phone:503-280-1101
Mailing Address - Fax:503-280-9798
Practice Address - Street 1:1934 NE BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1502
Practice Address - Country:US
Practice Address - Phone:503-280-1101
Practice Address - Fax:503-280-9798
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical