Healthcare Provider Details

I. General information

NPI: 1972661486
Provider Name (Legal Business Name): MURRAY R RODNICK LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6507 S SANTA FE DR
LITTLETON CO
80120-2910
US

IV. Provider business mailing address

8129 S COLUMBINE DR
MORRISON CO
80465-2461
US

V. Phone/Fax

Practice location:
  • Phone: 303-730-0797
  • Fax:
Mailing address:
  • Phone: 303-697-8947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number986109
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: