Provider Demographics
NPI:1033748306
Name:POROSHINA, SVETLANA V
Entity type:Individual
Prefix:
First Name:SVETLANA
Middle Name:V
Last Name:POROSHINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 NE MLK
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2941
Mailing Address - Country:US
Mailing Address - Phone:503-232-1099
Mailing Address - Fax:
Practice Address - Street 1:5225 JEAN RD APT 505
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-7155
Practice Address - Country:US
Practice Address - Phone:503-432-7681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health