Provider Demographics
NPI:1760039069
Name:HABERKORN-GOMEZ, ANYSSA N (LCSW)
Entity Type:Individual
Prefix:
First Name:ANYSSA
Middle Name:N
Last Name:HABERKORN-GOMEZ
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 1:7515 FALCON CREST DR # 200
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-5014
Mailing Address - Country:US
Mailing Address - Phone:541-316-9442
Mailing Address - Fax:
Practice Address - Street 1:7515 FALCON CREST DR # 200
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-5014
Practice Address - Country:US
Practice Address - Phone:541-316-9442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA102661041C0700X
ORA109911041C0700X
OR112881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical