Provider Demographics
NPI:1336386481
Name:SERNA, JOANNE E (LCSW)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:E
Last Name:SERNA
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 1:38961 PIONEER BLVD
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:OR
Mailing Address - Zip Code:97055-8080
Mailing Address - Country:US
Mailing Address - Phone:503-740-1555
Mailing Address - Fax:503-914-1554
Practice Address - Street 1:38961 PIONEER BLVD
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:OR
Practice Address - Zip Code:97055-8080
Practice Address - Country:US
Practice Address - Phone:503-740-1555
Practice Address - Fax:503-740-1555
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL42731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR022959Medicaid
OR106622Medicare PIN
OR022959Medicaid