Individual
PAUL MARTIN RAKOCZY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW, CADC III
Contact information
Practice address
3939 NE HANCOCK ST, PORTLAND, OR 97212-5321
(503) 997-8611
(503) 669-0712
Mailing address
23953 NE ALDERCREST CIR, WOOD VILLAGE, OR 97060-1148
(503) 997-8611
(503) 669-0712
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L3965
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R146291
MEDICARE PTAN#
OR
Enumeration date
11/27/2007
Last updated
03/11/2015
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