Provider Demographics
NPI:1750513487
Name:ANDREWS, ROBERT M (LCSW, QCSW)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:M
Last Name:ANDREWS
Suffix:
Gender:M
Credentials:LCSW, QCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 NW 17TH AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2327
Mailing Address - Country:US
Mailing Address - Phone:503-703-9833
Mailing Address - Fax:
Practice Address - Street 1:818 NW 17TH AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2327
Practice Address - Country:US
Practice Address - Phone:503-703-9833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW-0006646-L1041C0700X
ORL40981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA746693Medicaid