Provider Demographics
NPI:1659371169
Name:SCARFO, LAURANELL (LCSW)
Entity Type:Individual
Prefix:
First Name:LAURANELL
Middle Name:
Last Name:SCARFO
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 1:3619 SW COMUS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-7510
Mailing Address - Country:US
Mailing Address - Phone:503-490-7277
Mailing Address - Fax:503-768-9232
Practice Address - Street 1:5327 NE GLISAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-3060
Practice Address - Country:US
Practice Address - Phone:503-490-7277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL27261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q46664Medicare UPIN
ORR131806Medicare PIN