Provider Demographics
NPI:1578963476
Name:SEPARA, LAURA MARIE (MA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:SEPARA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 SW 6TH AVE
Mailing Address - Street 2:SUITE 905
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-1533
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:506 SW 6TH AVE
Practice Address - Street 2:SUITE 905
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-1533
Practice Address - Country:US
Practice Address - Phone:503-223-5525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health