Provider Demographics
NPI:1992084743
Name:ARCHIBALD, CATHERINE ELIZABETH CHRISTINE (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:ELIZABETH CHRISTINE
Last Name:ARCHIBALD
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 SE 16TH ST
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-9322
Mailing Address - Country:US
Mailing Address - Phone:503-679-5242
Mailing Address - Fax:
Practice Address - Street 1:10157 SW BARBUR BLVD STE 107C
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-5910
Practice Address - Country:US
Practice Address - Phone:503-679-5242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR40421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical