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General NPI Number Information
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NPI Number | 1356203293
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Entity Type | Individual
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Provider Name | RODERICK THOMAS II
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Gender | Male
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Dates
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Enumeration Date | 12/01/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 4150 PARKSIDE AVE APT 202
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City | PHILADELPHIA
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State | PA
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Zip | 19104-7301
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Country | US
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Telephone | 267-428-6732
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Fax |
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Provider Business Mailing Address
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Address Line | 4150 PARKSIDE AVE APT 202
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City | PHILADELPHIA
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State | PA
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Zip | 19104-7301
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Country | US
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Telephone |
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Fax |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MF001686
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License Number State | PA
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