Provider Demographics
NPI:1588230338
Name:PERRINE, ELENA VICTORIA
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:VICTORIA
Last Name:PERRINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 ARBOR DR
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-1101
Mailing Address - Country:US
Mailing Address - Phone:818-428-9002
Mailing Address - Fax:
Practice Address - Street 1:738 NE DAVIS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2931
Practice Address - Country:US
Practice Address - Phone:503-542-4603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker