Provider Demographics
NPI:1023568490
Name:VERDUGO, REBEKAH E (LICSW, LCSW, SUDP)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:E
Last Name:VERDUGO
Suffix:
Gender:F
Credentials:LICSW, LCSW, SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 NW RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-9518
Mailing Address - Country:US
Mailing Address - Phone:775-544-5065
Mailing Address - Fax:
Practice Address - Street 1:1924 NW RUSSELL ST
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-9518
Practice Address - Country:US
Practice Address - Phone:775-544-5065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-10
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW612718581041C0700X
WACP61261902101YA0400X
NV9046-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)