Provider Demographics
NPI:1518193168
Name:SERRICCHIO, MARIA EUGENIA (MFTI-ATR)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:EUGENIA
Last Name:SERRICCHIO
Suffix:
Gender:F
Credentials:MFTI-ATR
Other - Prefix:
Other - First Name:MARU
Other - Middle Name:
Other - Last Name:SERRICCHIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1312 SW WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123
Mailing Address - Country:US
Mailing Address - Phone:503-693-3104
Mailing Address - Fax:310-829-8455
Practice Address - Street 1:205 SE 3RD AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4093
Practice Address - Country:US
Practice Address - Phone:503-693-3104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10OtherBEHAVIOR HEALTH AND SOCIAL SERVICE PROVIDERS