Healthcare Provider Details

I. General information

NPI: 1992084743
Provider Name (Legal Business Name): CATHERINE ELIZABETH CHRISTINE ARCHIBALD MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2011
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 NE 4TH ST STE 102
GRESHAM OR
97030-7496
US

IV. Provider business mailing address

410 SE 16TH ST
GRESHAM OR
97080-9322
US

V. Phone/Fax

Practice location:
  • Phone: 503-679-5242
  • Fax: 503-679-5242
Mailing address:
  • Phone: 503-679-5242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4042
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: