Provider Demographics
NPI:1124343827
Name:KATHERINE CALVERT LLC
Entity type:Organization
Organization Name:KATHERINE CALVERT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:YERXA
Authorized Official - Last Name:CALVERT
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:503-705-2194
Mailing Address - Street 1:4531 SE BELMONT ST
Mailing Address - Street 2:SUITE203
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-1675
Mailing Address - Country:US
Mailing Address - Phone:503-705-2194
Mailing Address - Fax:503-841-5816
Practice Address - Street 1:4531 SE BELMONT ST
Practice Address - Street 2:SUITE 203
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-1675
Practice Address - Country:US
Practice Address - Phone:503-705-2194
Practice Address - Fax:503-841-5816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-06
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR L32751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty