Provider Demographics
NPI:1700141983
Name:BEROVIC, SAMANTHA ADRIANA (LCSW)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ADRIANA
Last Name:BEROVIC
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:ADRIANA
Other - Last Name:HORMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7201 N INTERSTATE AVENUE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217
Mailing Address - Country:US
Mailing Address - Phone:503-813-2000
Mailing Address - Fax:503-286-6879
Practice Address - Street 1:7201 N INTERSTATE AVENUE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217
Practice Address - Country:US
Practice Address - Phone:503-813-2000
Practice Address - Fax:503-286-6879
Is Sole Proprietor?:No
Enumeration Date:2012-07-12
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL78401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical