Provider Demographics
NPI:1760242739
Name:CLARE, PATRICK DAVID ((CADC I, BSW, PWS))
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:DAVID
Last Name:CLARE
Suffix:
Gender:M
Credentials:(CADC I, BSW, PWS)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 NE 127TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-2410
Mailing Address - Country:US
Mailing Address - Phone:503-593-1331
Mailing Address - Fax:
Practice Address - Street 1:313 NE 127TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-2410
Practice Address - Country:US
Practice Address - Phone:503-593-1331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22-06-10447101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)