Provider Demographics
NPI:1679370209
Name:BRISENO, LUCY T (CHW, PSS)
Entity type:Individual
Prefix:
First Name:LUCY
Middle Name:T
Last Name:BRISENO
Suffix:
Gender:
Credentials:CHW, PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 WHITE OAK CIR APT 238
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97351-8637
Mailing Address - Country:US
Mailing Address - Phone:503-428-0928
Mailing Address - Fax:
Practice Address - Street 1:730 WHITE OAK CIR APT 238
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OR
Practice Address - Zip Code:97351-8637
Practice Address - Country:US
Practice Address - Phone:503-428-0928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-01
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR110783172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker