Provider Demographics
NPI:1932436557
Name:SANCHEZ, XIOMARA RAQUEL (LCSW)
Entity Type:Individual
Prefix:MS
First Name:XIOMARA
Middle Name:RAQUEL
Last Name:SANCHEZ
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 1:1532 NE 21ST AVE APT 302
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1535
Mailing Address - Country:US
Mailing Address - Phone:305-968-6140
Mailing Address - Fax:
Practice Address - Street 1:7440 SW HUNZIKER ST
Practice Address - Street 2:SUITE F
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8245
Practice Address - Country:US
Practice Address - Phone:503-596-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL56391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL766432000Medicaid