Healthcare Provider Details

I. General information

NPI: 1023568490
Provider Name (Legal Business Name): REBEKAH E VERDUGO LICSW, LCSW, SUDP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2016
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 NW RUSSELL ST
POULSBO WA
98370-9518
US

IV. Provider business mailing address

1924 NW RUSSELL ST
POULSBO WA
98370-9518
US

V. Phone/Fax

Practice location:
  • Phone: 775-544-5065
  • Fax:
Mailing address:
  • Phone: 775-544-5065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP61261902
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW61271858
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9046-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: