Provider Demographics
NPI:1295236628
Name:BENTON, RAMON (MSW, CSWA)
Entity type:Individual
Prefix:MR
First Name:RAMON
Middle Name:
Last Name:BENTON
Suffix:
Gender:M
Credentials:MSW, CSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5686 NE 42ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97218-1410
Mailing Address - Country:US
Mailing Address - Phone:334-552-1516
Mailing Address - Fax:
Practice Address - Street 1:2951 NW DIVISION ST STE 120
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-5293
Practice Address - Country:US
Practice Address - Phone:503-752-3088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health