Provider Demographics
NPI:1760504807
Name:BARNETT, SEAN ERIK (LCSW)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:ERIK
Last Name:BARNETT
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 1:530 NW 23RD AVE
Mailing Address - Street 2:SUITE 117
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3275
Mailing Address - Country:US
Mailing Address - Phone:323-703-2831
Mailing Address - Fax:
Practice Address - Street 1:2415 SE 43RD AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-1600
Practice Address - Country:US
Practice Address - Phone:503-230-9634
Practice Address - Fax:503-239-5953
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA2934101YM0800X
ORL51151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health