Provider Demographics
NPI:1376176644
Name:MITSINA-BROWN, SVIATLANA (PSYD)
Entity Type:Individual
Prefix:
First Name:SVIATLANA
Middle Name:
Last Name:MITSINA-BROWN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:SVETLANA
Other - Middle Name:
Other - Last Name:MITSINA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:15480 SW BUNTING ST APT 106
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-8784
Mailing Address - Country:US
Mailing Address - Phone:503-277-9505
Mailing Address - Fax:
Practice Address - Street 1:2600 CENTER ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2669
Practice Address - Country:US
Practice Address - Phone:503-945-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2694103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical