Provider Demographics
NPI:1609390764
Name:MAHER, REBECCA M (LCSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:M
Last Name:MAHER
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 1:5228 NE HOYT ST BLDG B1
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-3055
Mailing Address - Country:US
Mailing Address - Phone:503-216-6474
Mailing Address - Fax:
Practice Address - Street 1:5228 NE HOYT ST BLDG B1
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-3055
Practice Address - Country:US
Practice Address - Phone:503-216-6474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL114921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical