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General NPI Number Information
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NPI Number | 1194084830
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Entity Type | Organization
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Legal Business Name | SOMA TRAUMA THERAPY, LLC
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Dates
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Enumeration Date | 05/15/2012
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Last Update Date | 05/15/2012
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Provider Practice Location Address
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Address Line | 833 SW 11TH AVE SUITE 320
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City | PORTLAND
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State | OR
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Zip | 97205-2125
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Country | US
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Telephone | 503-227-5692
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Fax | 506-227-8183
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Provider Business Mailing Address
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Address Line | 833 SW 11TH AVE SUITE 320
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City | PORTLAND
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State | OR
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Zip | 97205-2125
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Country | US
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Telephone | 503-227-5692
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Fax | 506-227-8183
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MS. BEVERLY LOIS SCHWARTZ
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Credential | LCSW
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Telephone | 503-227-5692
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | L2048
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License Number State | OR
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