Provider Demographics
NPI:1720396989
Name:SHERBENOU, CAROL ELLIOTT (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ELLIOTT
Last Name:SHERBENOU
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 1:3930 SE DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1643
Mailing Address - Country:US
Mailing Address - Phone:503-418-8248
Mailing Address - Fax:503-418-3998
Practice Address - Street 1:3930 SE DIVISION ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1643
Practice Address - Country:US
Practice Address - Phone:503-418-8248
Practice Address - Fax:503-418-3998
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL27071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical