=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841813946
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LINA SOARES, LCSW, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2020
-----------------------------------------------------
Last Update Date | 05/06/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 636 SW 2ND ST
-----------------------------------------------------
City | CORVALLIS
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97333-4442
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-230-8497
-----------------------------------------------------
Fax | 541-600-3330
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1923 SW BROOKLANE DR
-----------------------------------------------------
City | CORVALLIS
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97333-1627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-230-8497
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. LINA H SOARES
-----------------------------------------------------
Credential | MSW, LCSW
-----------------------------------------------------
Telephone | 541-230-8497
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------