Healthcare Provider Details

I. General information

NPI: 1265633499
Provider Name (Legal Business Name): YOLANDA PATRICIA HAWKINS-RODGERS ED.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 EUCLID AVE
HACKENSACK NJ
07601-4608
US

IV. Provider business mailing address

105 EUCLID AVE
HACKENSACK NJ
07601-4608
US

V. Phone/Fax

Practice location:
  • Phone: 201-489-3607
  • Fax: 210-489-3608
Mailing address:
  • Phone: 201-489-3607
  • Fax: 210-489-3608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4406
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: