Provider Demographics
NPI:1003375551
Name:CASANOVA, REBECCA X (LCSW, MPH)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:X
Last Name:CASANOVA
Suffix:
Gender:F
Credentials:LCSW, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 SE 26TH AVE STE D
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1288
Mailing Address - Country:US
Mailing Address - Phone:971-378-9436
Mailing Address - Fax:971-339-8511
Practice Address - Street 1:2700 SE 26TH AVE STE D
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1288
Practice Address - Country:US
Practice Address - Phone:971-378-9436
Practice Address - Fax:971-339-8511
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-14
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR67801041C0700X
ORL67801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical