Provider Demographics
NPI:1568568293
Name:GITELSON, ROBERT EVEN (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:EVEN
Last Name:GITELSON
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10711 SW MCKINNEY ST
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-7391
Mailing Address - Country:US
Mailing Address - Phone:503-691-6863
Mailing Address - Fax:
Practice Address - Street 1:4720 RIVER RD N
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-4536
Practice Address - Country:US
Practice Address - Phone:503-390-4352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL2081101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health