Healthcare Provider Details

I. General information

NPI: 1912176116
Provider Name (Legal Business Name): KIMBERLY GOLDSTIEN MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 01/20/2020
Certification Date: 01/20/2020
Deactivation Date: 01/21/2010
Reactivation Date: 10/17/2019

III. Provider practice location address

2800 N VANCOUVER AVE STE 201
PORTLAND OR
97227-1648
US

IV. Provider business mailing address

PO BOX 4037
PORTLAND OR
97208-4037
US

V. Phone/Fax

Practice location:
  • Phone: 503-276-9000
  • Fax: 503-276-9010
Mailing address:
  • Phone: 503-413-4048
  • Fax: 503-413-2910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL3934
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: