Provider Demographics
NPI:1548776511
Name:ROSS, ROBERT CHARLES (LCSW, C-CATODSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:CHARLES
Last Name:ROSS
Suffix:
Gender:M
Credentials:LCSW, C-CATODSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13190 SW TRIGGER DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-7689
Mailing Address - Country:US
Mailing Address - Phone:503-453-3968
Mailing Address - Fax:
Practice Address - Street 1:12250 SW 2ND ST
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2828
Practice Address - Country:US
Practice Address - Phone:971-249-2319
Practice Address - Fax:503-601-0049
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-28
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical