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General NPI Number Information
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NPI Number | 1164908182
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Entity Type | Individual
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Provider Name | KIT B O'BOYLE RN, BSN, MSW, LCSW
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Gender | Male
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Dates
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Enumeration Date | 07/12/2018
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Last Update Date | 05/11/2026
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Provider Practice Location Address
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Address Line | 4733 NE 104TH AVE
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City | PORTLAND
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State | OR
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Zip | 97220-3347
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Country | US
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Telephone | 303-990-2744
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Fax |
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Provider Business Mailing Address
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Address Line | 4798 NE GOING ST
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City | PORTLAND
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State | OR
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Zip | 97218-2002
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Country | US
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Telephone | 303-990-2744
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | L17485
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number | 201607356RN
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License Number State | OR
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