Provider Demographics
NPI:1326096512
Name:CALVERT, KATHERINE YERXA (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:YERXA
Last Name:CALVERT
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 1:4531 SE BELMONT ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-1675
Mailing Address - Country:US
Mailing Address - Phone:503-234-4440
Mailing Address - Fax:503-200-5550
Practice Address - Street 1:4511 SE 39TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-3119
Practice Address - Country:US
Practice Address - Phone:503-957-5867
Practice Address - Fax:503-841-5816
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL32751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR134503Medicare PIN