MEDICARE: MARY T RICH PHD,LCSW

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	3664	OR

General Provider Information

NPI Number	:	1457467011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY T RICH PHD,LCSW

Provider Business Mailing Address
First Line	:	1420 NW LOVEJOY ST APT 503
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97209-2744
Country	:	US
Telephone Number	:	503-228-4222
Fax Number	:

Provider Business Practice Location Address
First Line	:	1420 NW LOVEJOY ST APT 503
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97209-2744
Country	:	US
Telephone Number	:	503-228-4222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	04/19/2026

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