Provider Demographics
NPI:1598919680
Name:BERDINE, RUBY LOUISA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RUBY
Middle Name:LOUISA
Last Name:BERDINE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2841 NE 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-3408
Mailing Address - Country:US
Mailing Address - Phone:971-227-2063
Mailing Address - Fax:503-325-2821
Practice Address - Street 1:3939 NE HANCOCK ST STE 316
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-5321
Practice Address - Country:US
Practice Address - Phone:971-227-2063
Practice Address - Fax:503-325-2821
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-16
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2275103TC0700X
OR101YA0400X
OR2275OR103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)