Provider Demographics
NPI:1073060083
Name:LEMOS, ALBIE M (CSWA/QMHP-C)
Entity Type:Individual
Prefix:
First Name:ALBIE
Middle Name:M
Last Name:LEMOS
Suffix:
Gender:M
Credentials:CSWA/QMHP-C
Other - Prefix:
Other - First Name:ALBERT
Other - Middle Name:MANUEL
Other - Last Name:LEMOS
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:CSWA/QMHP-C
Mailing Address - Street 1:1776 SW MADISON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-1715
Mailing Address - Country:US
Mailing Address - Phone:503-224-1044
Mailing Address - Fax:503-621-2235
Practice Address - Street 1:620 NE 2ND ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7514
Practice Address - Country:US
Practice Address - Phone:971-274-3757
Practice Address - Fax:503-912-5740
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA12752104100000X, 104100000X
OR23-QMHPC-001273101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500714306Medicaid
OR500738493Medicaid