Provider Demographics
NPI:1043513120
Name:GREGORY, ROBYN G (LCSW)
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:G
Last Name:GREGORY
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 1:4021 SE MADISON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-4423
Mailing Address - Country:US
Mailing Address - Phone:503-358-5296
Mailing Address - Fax:
Practice Address - Street 1:319 SW WASHINGTON ST
Practice Address - Street 2:SUITE 1015
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-2635
Practice Address - Country:US
Practice Address - Phone:503-358-5296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-13
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical