MEDICARE: MIRIAM L ROBINSON, LICENSED CLINICAL SOCIAL WORKER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1235425505
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIRIAM L ROBINSON, LICENSED CLINICAL SOCIAL WORKER, LLC

Provider Business Mailing Address
First Line	:	5331 S MACADAM AVE STE 283
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-3849
Country	:	US
Telephone Number	:	503-465-5708
Fax Number	:	503-465-5707

Provider Business Practice Location Address
First Line	:	5331 S MACADAM AVE STE 283
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-3849
Country	:	US
Telephone Number	:	503-465-5708
Fax Number	:	503-465-5707

Authorized Official
Title or Position	:	OWNER
Name	:	MS. MIRIAM LOUISE ROBINSON
Credential	:	LCSW
Telephone Number	:	503-465-5708

Provider Enumeration Date	:	06/24/2011
Last Update Date	:	06/23/2024

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