Provider Demographics
NPI:1659517894
Name:SORENSON, PAUL E (LCSW)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:E
Last Name:SORENSON
Suffix:
Gender:M
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:PO BOX 1114
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-4114
Mailing Address - Country:US
Mailing Address - Phone:503-608-8735
Mailing Address - Fax:503-608-8735
Practice Address - Street 1:1909 MOUNTAIN VIEW LN
Practice Address - Street 2:STE 200
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-2894
Practice Address - Country:US
Practice Address - Phone:503-608-8735
Practice Address - Fax:503-608-8735
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-17
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL41391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR139431Medicaid
OR139670Medicaid
OR139431Medicaid