Provider Demographics
NPI:1518207661
Name:GOBLE, ROBERT CHRISTOPHER (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:CHRISTOPHER
Last Name:GOBLE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 NE IRVING ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2243
Mailing Address - Country:US
Mailing Address - Phone:503-595-2260
Mailing Address - Fax:877-263-7778
Practice Address - Street 1:1500 NE IRVING ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2243
Practice Address - Country:US
Practice Address - Phone:503-595-2260
Practice Address - Fax:877-263-7778
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL54191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR275482Medicaid
OR275482Medicaid