Healthcare Provider Details

I. General information

NPI: 1922757517
Provider Name (Legal Business Name): RACHEL RODENO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 03/21/2022
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1763 VINE ST
DENVER CO
80206-1119
US

IV. Provider business mailing address

1763 VINE ST
DENVER CO
80206-1119
US

V. Phone/Fax

Practice location:
  • Phone: 402-681-5886
  • Fax:
Mailing address:
  • Phone: 402-681-5886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09925813
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: