Provider Demographics
NPI:1912322363
Name:SMITH, CATHERINE ANGELA (LCSW)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANGELA
Last Name:SMITH
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 1:1909 MOUNTAIN VIEW LN STE 200
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-2894
Mailing Address - Country:US
Mailing Address - Phone:503-359-4773
Mailing Address - Fax:503-359-3809
Practice Address - Street 1:2800 N VANCOUVER AVE
Practice Address - Street 2:SUITE 165
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1630
Practice Address - Country:US
Practice Address - Phone:503-413-1626
Practice Address - Fax:503-413-5220
Is Sole Proprietor?:No
Enumeration Date:2014-02-21
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical