Provider Demographics
NPI:1982976874
Name:DELANO, KATELYN RUBERT (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:RUBERT
Last Name:DELANO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:MARIE
Other - Last Name:RUBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:930 NW 12TH AVE
Mailing Address - Street 2:APT 216
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3066
Mailing Address - Country:US
Mailing Address - Phone:732-233-7820
Mailing Address - Fax:
Practice Address - Street 1:930 NW 12TH AVE
Practice Address - Street 2:APT 216
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3066
Practice Address - Country:US
Practice Address - Phone:732-233-7820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL4633101YA0400X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORL4633OtherOREGON BOARD OF LICENSED SOCIAL WORKERS