Provider Demographics
NPI:1245481043
Name:LUNDY, SARAH JEAN (LCSW)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:JEAN
Last Name:LUNDY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92004
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97292-2004
Mailing Address - Country:US
Mailing Address - Phone:503-855-0955
Mailing Address - Fax:
Practice Address - Street 1:216 CASCADE AVE STE 25
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-2239
Practice Address - Country:US
Practice Address - Phone:503-855-0955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-10
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL61091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR191355Medicare UPIN