Individual
JULIANNA BRIDGET LUCISANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, CADC I
Contact information
Practice address
9555 SW BARNES RD, SUITE 100, PORTLAND, OR 97225-6663
(503) 292-3577
Mailing address
7650 SW BEVELAND RD, SUITE 200, PORTLAND, OR 97223-8692
(503) 292-3577
(503) 292-3947
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
L6007
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500670853
—
OR
01
—
R183635
MEDICARE PTAN
OR
Enumeration date
07/07/2011
Last updated
07/11/2016
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