Provider Demographics
NPI:1720195951
Name:RAPPAPORT, JESSE (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:RAPPAPORT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 SW MULTNOMAH BLVD STE 307
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-4072
Mailing Address - Country:US
Mailing Address - Phone:503-407-9349
Mailing Address - Fax:
Practice Address - Street 1:2929 SW MULTNOMAH BLVD STE 307
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-4072
Practice Address - Country:US
Practice Address - Phone:503-407-9349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1077OtherSTATE LICENSE NUMBER
OR1077OtherSTATE LICENSE NUMBER
OR158661Medicare PIN