Provider Demographics
NPI:1700822756
Name:FIFER, BEATRICE A (LCSW)
Entity Type:Individual
Prefix:
First Name:BEATRICE
Middle Name:A
Last Name:FIFER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TRISS
Other - Middle Name:A
Other - Last Name:FIFER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:833 SW 11TH AVE
Mailing Address - Street 2:913
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2125
Mailing Address - Country:US
Mailing Address - Phone:503-222-2420
Mailing Address - Fax:503-222-5395
Practice Address - Street 1:833 SW 11TH AVE
Practice Address - Street 2:913
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2125
Practice Address - Country:US
Practice Address - Phone:503-222-2420
Practice Address - Fax:503-222-5395
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR#16981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical