Provider Demographics
NPI:1225547235
Name:ROBERTS, RICHARD RHETT (MSW, CADC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:RHETT
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 NE FLANDERS ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-3158
Mailing Address - Country:US
Mailing Address - Phone:818-497-7457
Mailing Address - Fax:
Practice Address - Street 1:10564 SE WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2809
Practice Address - Country:US
Practice Address - Phone:503-228-9229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program