Provider Demographics
NPI:1790844744
Name:ROBINSON, MIRIAM LOUISE (LCSW)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:LOUISE
Last Name:ROBINSON
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 1:5331 S MACADAM AVE
Mailing Address - Street 2:208
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3851
Mailing Address - Country:US
Mailing Address - Phone:503-465-5708
Mailing Address - Fax:503-465-5707
Practice Address - Street 1:5331 S MACADAM AVE
Practice Address - Street 2:208
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-6403
Practice Address - Country:US
Practice Address - Phone:503-465-5708
Practice Address - Fax:503-465-5707
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
OR16781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6007349Medicaid