MEDICARE: MR. ROBERT EVEN GITELSON MSW, 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	101YM0800X	Mental Health Counselor	L2081	OR

General Provider Information

NPI Number	:	1568568293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT EVEN GITELSON MSW, LCSW

Provider Business Mailing Address
First Line	:	10711 SW MCKINNEY ST
Second Line	:
City	:	TUALATIN
State	:	OR
Zip	:	97062-7391
Country	:	US
Telephone Number	:	503-691-6863
Fax Number	:

Provider Business Practice Location Address
First Line	:	4720 RIVER RD N
Second Line	:
City	:	KEIZER
State	:	OR
Zip	:	97303-4536
Country	:	US
Telephone Number	:	503-390-4352
Fax Number	:

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

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	07/08/2007

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