Provider Demographics
NPI:1912271511
Name:BLOCK, REBECCA G (LCSW, MSW, PHD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:G
Last Name:BLOCK
Suffix:
Gender:F
Credentials:LCSW, MSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 SW BOND AVE
Mailing Address - Street 2:CH15R
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4501
Mailing Address - Country:US
Mailing Address - Phone:503-494-6047
Mailing Address - Fax:503-494-3224
Practice Address - Street 1:3303 SW BOND AVE
Practice Address - Street 2:CH15R
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4501
Practice Address - Country:US
Practice Address - Phone:503-494-6047
Practice Address - Fax:503-494-3224
Is Sole Proprietor?:No
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL43641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical