Provider Demographics
NPI:1831380757
Name:ROBUSTELLI, ELIZABETH GRACE
Entity type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:GRACE
Last Name:ROBUSTELLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6435 SE 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-5525
Mailing Address - Country:US
Mailing Address - Phone:503-231-2702
Mailing Address - Fax:
Practice Address - Street 1:6435 SE 18TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-5525
Practice Address - Country:US
Practice Address - Phone:503-231-2702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9700806101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor