Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Clement Nisbet Wilson Fonseca, LCSW

Individual provider Clinical Social Worker · NPI 1124539879

Clement Nisbet Wilson Fonseca, LCSW is a Clinical Social Worker in Portland, Oregon. Practices as a sole proprietor. Licensed in Oregon.

Licensed in
OR
In the registry since
2017
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

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Practice location Address checks out

3125B NE Holladay St
Portland, OR 97232-2504
Phone: (503) 217-4457
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence L11642 (OR)

Record details

NPI number1124539879
Entity typeIndividual (Type 1)
GenderMale
Credentials LCSW
Sole proprietorYes
NPI enumeratedOctober 21, 2017
Last updated in NPPESSeptember 2, 2025
Certification dateSeptember 2, 2025

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