Provider Demographics
NPI:1578378931
Name:PALICI, SIRENNA BROWN (MS, MBA)
Entity type:Individual
Prefix:
First Name:SIRENNA
Middle Name:BROWN
Last Name:PALICI
Suffix:
Gender:F
Credentials:MS, MBA
Other - Prefix:
Other - First Name:SIRENNA
Other - Middle Name:ANN
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6226 N WILBUR AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-4235
Mailing Address - Country:US
Mailing Address - Phone:503-929-1233
Mailing Address - Fax:503-345-0276
Practice Address - Street 1:6226 N WILBUR AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-4235
Practice Address - Country:US
Practice Address - Phone:503-929-1233
Practice Address - Fax:503-345-0276
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR99813103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool