MEDICARE: MR. MURRAY R RODNICK LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320800000X	Mental Illness Community Based Residential Treatment Facility	986109	CO

General Provider Information

NPI Number	:	1972661486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MURRAY R RODNICK LCSW

Provider Business Mailing Address
First Line	:	8129 S COLUMBINE DR
Second Line	:
City	:	MORRISON
State	:	CO
Zip	:	80465-2461
Country	:	US
Telephone Number	:	303-697-8947
Fax Number	:

Provider Business Practice Location Address
First Line	:	6507 S SANTA FE DR
Second Line	:
City	:	LITTLETON
State	:	CO
Zip	:	80120-2910
Country	:	US
Telephone Number	:	303-730-0797
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	07/08/2007

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