Provider Demographics
NPI:1720395262
Name:MARCIN, REBECCA NICOLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:NICOLE
Last Name:MARCIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6443 SW BEAVERTON HILLSDALE HWY
Mailing Address - Street 2:STE 300
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-1164
Mailing Address - Country:US
Mailing Address - Phone:503-452-8002
Mailing Address - Fax:
Practice Address - Street 1:6443 SW BEAVERTON HILLSDALE HWY
Practice Address - Street 2:STE 300
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221-1164
Practice Address - Country:US
Practice Address - Phone:503-452-8002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-03
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2788103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical