Provider Demographics
NPI:1710472543
Name:CARVALHO, RAI D (CSWA)
Entity Type:Individual
Prefix:
First Name:RAI
Middle Name:D
Last Name:CARVALHO
Suffix:
Gender:M
Credentials:CSWA
Other - Prefix:
Other - First Name:RYAN
Other - Middle Name:D
Other - Last Name:CARVALHO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11 NE MARTIN LUTHER KING JR BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-3579
Mailing Address - Country:US
Mailing Address - Phone:971-350-3401
Mailing Address - Fax:971-350-3401
Practice Address - Street 1:11 NE MARTIN LUTHER KING JR BLVD STE 203
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-3579
Practice Address - Country:US
Practice Address - Phone:971-350-1122
Practice Address - Fax:971-350-3401
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
ORA5675104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker