Healthcare Provider Details

I. General information

NPI: 1578892386
Provider Name (Legal Business Name): JOSEPH RHINEWINE, PHD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2009
Last Update Date: 12/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 SW 5TH AVE STE 725
PORTLAND OR
97204-2133
US

IV. Provider business mailing address

522 SW 5TH AVE STE 725
PORTLAND OR
97204-2133
US

V. Phone/Fax

Practice location:
  • Phone: 503-222-2361
  • Fax: 503-222-2395
Mailing address:
  • Phone: 503-222-2361
  • Fax: 503-222-2395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1754
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4549
License Number StateOR

VIII. Authorized Official

Name: DR. JOSEPH RHINEWINE
Title or Position: DIRECTOR
Credential: PHD
Phone: 503-222-2361