Provider Demographics
NPI:1912176116
Name:GOLDSTIEN, KIMBERLY (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:GOLDSTIEN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4037
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4037
Mailing Address - Country:US
Mailing Address - Phone:503-413-4048
Mailing Address - Fax:503-413-2910
Practice Address - Street 1:2800 N VANCOUVER AVE STE 201
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1648
Practice Address - Country:US
Practice Address - Phone:503-276-9000
Practice Address - Fax:503-276-9010
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2020-01-20
Deactivation Date:2010-01-21
Deactivation Code:
Reactivation Date:2019-10-17
Provider Licenses
StateLicense IDTaxonomies
ORL39341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical