Provider Demographics
NPI:1811586084
Name:NERI, KAREN ANDAL (JD, MA)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ANDAL
Last Name:NERI
Suffix:
Gender:F
Credentials:JD, MA
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:ANDAL
Other - Last Name:NERI PACK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3407 S CORBETT AVE # 7
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4621
Mailing Address - Country:US
Mailing Address - Phone:503-208-4687
Mailing Address - Fax:
Practice Address - Street 1:3407 S CORBETT AVE # 7
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4621
Practice Address - Country:US
Practice Address - Phone:503-744-2980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-13
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC7592101YP2500X
ORT2479106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional