Provider Demographics
NPI:1831691039
Name:RUDERMAN, CAITLIN (LCSW)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:RUDERMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1337 NE BUFFALO ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-4755
Mailing Address - Country:US
Mailing Address - Phone:347-525-5335
Mailing Address - Fax:
Practice Address - Street 1:399 E 10TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3380
Practice Address - Country:US
Practice Address - Phone:541-868-2004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-02
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR119011041C0700X
175T00000X, 171W00000X
ORA131221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty
No171W00000XOther Service ProvidersContractorGroup - Single Specialty