Provider Demographics
NPI:1619799574
Name:RAFTERY, REBEKAH REILLY (PWS, CADC-R)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:REILLY
Last Name:RAFTERY
Suffix:
Gender:F
Credentials:PWS, CADC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 NE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1134
Mailing Address - Country:US
Mailing Address - Phone:971-900-2532
Mailing Address - Fax:
Practice Address - Street 1:1621 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1134
Practice Address - Country:US
Practice Address - Phone:971-900-2532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175T00000X
ORT-24-4276101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist