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General NPI Number Information
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NPI Number | 1700335007
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Entity Type | Individual
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Provider Name | CARISSA EMORY LCSW, LICSW
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Gender | Female
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Dates
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Enumeration Date | 09/27/2016
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 2301 NW THURMAN ST STE F
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City | PORTLAND
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State | OR
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Zip | 97210-2581
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Country | US
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Telephone | 971-350-8892
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Fax | 971-277-7697
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Provider Business Mailing Address
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Address Line | 2301 NW THURMAN ST STE F
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City | PORTLAND
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State | OR
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Zip | 97210-2581
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Country | US
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Telephone | 971-350-8892
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Fax | 971-277-7697
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | LW61084473
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | L12292
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License Number State | OR
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