Provider Demographics
NPI:1306330394
Name:HALPERN, RICHARD (MA)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:HALPERN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 SW DICKINSON ST APT 7
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-0901
Mailing Address - Country:US
Mailing Address - Phone:541-490-1551
Mailing Address - Fax:
Practice Address - Street 1:10211 SW BARBUR BLVD STE 105A
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-5934
Practice Address - Country:US
Practice Address - Phone:541-490-1551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA340097E101YS0200X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool