Provider Demographics
NPI:1003060088
Name:RACE, ELIZABETH SUTHERLAND (LCSW)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:SUTHERLAND
Last Name:RACE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-3938
Mailing Address - Country:US
Mailing Address - Phone:503-624-5705
Mailing Address - Fax:503-697-1860
Practice Address - Street 1:420 S STATE ST
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-3938
Practice Address - Country:US
Practice Address - Phone:503-624-5705
Practice Address - Fax:503-697-1860
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical