Individual provider Active NPI

Anyssa N Haberkorn-Gomez, LCSW

  • Clinical Social Worker
  • Redmond, OR
National Provider Identifier
1760039069
Registry record updated May 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
11288 Issued in OR
Practice address
7515 Falcon Crest Dr # 200
Redmond, OR 97756-5014
Phone
(541) 904-5216
Fax
(541) 527-4347
NPI assigned
Aug 21, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 21, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 11288 OR Primary

Addresses

Primary practice location

7515 Falcon Crest Dr # 200
Redmond, OR 97756-5014

Mailing address

7515 Falcon Crest Dr # 200
Redmond, OR 97756-5014
Phone (541) 316-9442

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230330002455 OR Practitioner - Clinical Social Worker 3274908462 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Brightways Counseling Group LLCGroup PAC ID 4688907827, 36 clinicians

Practice addresses (Care Compare)

7515 Falcon Crest Dr
Suite 200
Redmond, OR 97756-5014
Phone (541) 904-5216

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11288ORMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Bright Horizons Psychiatric Group LLC CurrentSince Sep 1, 2023 Accepting new patients
Brightways Counseling Group LLC Clinical CurrentSince Feb 23, 2023 Accepting new patients

Locations

7515 Falcon Crest Dr
#200
Redmond, OR 97756

7515 Falcon Crest Dr
Ste 200
Redmond, OR 97756
Phone (541) 693-4669

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1566345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747785600000",
    "number": "1760039069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7515 FALCON CREST DR # 200",
            "city": "REDMOND",
            "state": "OR",
            "postal_code": "977565014",
            "telephone_number": "541-316-9442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7515 FALCON CREST DR # 200",
            "city": "REDMOND",
            "state": "OR",
            "postal_code": "977565014",
            "telephone_number": "541-904-5216",
            "fax_number": "541-527-4347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HABERKORN-GOMEZ",
        "first_name": "ANYSSA",
        "middle_name": "N",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-21",
        "last_updated": "2025-05-21",
        "certification_date": "2025-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "11288",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Redmond, OR

Sources for this page

Verify at the official NPI Registry.