Provider Demographics
NPI:1255909248
Name:SANA PSYCHIATRY LLC
Entity type:Organization
Organization Name:SANA PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:SANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:971-717-4866
Mailing Address - Street 1:1002 SE 54TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-2654
Mailing Address - Country:US
Mailing Address - Phone:503-386-0729
Mailing Address - Fax:503-386-0729
Practice Address - Street 1:1002 SE 54TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-2654
Practice Address - Country:US
Practice Address - Phone:503-386-0729
Practice Address - Fax:503-386-0729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty