Provider Demographics
NPI:1386869220
Name:BROWNSTEIN, GERALDINE RUTH (MS LCSW)
Entity type:Individual
Prefix:
First Name:GERALDINE
Middle Name:RUTH
Last Name:BROWNSTEIN
Suffix:
Gender:F
Credentials:MS LCSW
Other - Prefix:
Other - First Name:GERI
Other - Middle Name:
Other - Last Name:BROWNSTEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS LCSW
Mailing Address - Street 1:5256 SW CENTERWOOD ST
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035
Mailing Address - Country:US
Mailing Address - Phone:503-624-2045
Mailing Address - Fax:
Practice Address - Street 1:15800 SW BOONES FERRY RD
Practice Address - Street 2:SUITE A 10
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035
Practice Address - Country:US
Practice Address - Phone:503-699-1165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0028791041C0700X
CA203631041C0700X
FL00023061041C0700X
WALW000060151041C0700X
NY0132521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORJ9978OtherPACIFIC SOURCE HEALTH PLA