Provider Demographics
NPI:1538342530
Name:CLOCK, REBECCA (LCSW, LICSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:CLOCK
Suffix:
Gender:F
Credentials:LCSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 W B ST FL 4
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-3537
Mailing Address - Country:US
Mailing Address - Phone:253-843-7851
Mailing Address - Fax:
Practice Address - Street 1:4223 69TH STREET CT
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-8386
Practice Address - Country:US
Practice Address - Phone:617-308-2384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-12
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1041C0700X
WALW612245091041C0700X
CALCSW710111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical