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General NPI Number Information
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NPI Number | 1205478088
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Entity Type | Individual
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Provider Name | RODERICK VINCENT TODD RECOVERY PRACTIONER
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Gender | Male
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Dates
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Enumeration Date | 10/12/2019
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 1873 W 54TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90062-2604
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Country | US
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Telephone | 424-440-5660
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Fax | 310-349-3660
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Provider Business Mailing Address
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Address Line | 1873 W 54TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90062-2604
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Country | US
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Telephone | 424-440-5660
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Fax | 310-349-3660
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 172A00000X
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Taxonomy Name | Driver
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License Number |
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State | CA
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Taxonomy #6
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number |
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License Number State | CA
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Taxonomy #7
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State | CA
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