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General NPI Number Information
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NPI Number | 1487479960
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Entity Type | Individual
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Provider Name | RODNEY DALZON
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Gender | Male
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Dates
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Enumeration Date | 11/19/2024
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 12 SOUTHERN AVE
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City | DORCHESTER
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State | MA
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Zip | 02124-2012
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Country | US
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Telephone | 617-708-0870
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Fax |
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Provider Business Mailing Address
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Address Line | 100 WAYNE ST
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City | PROVIDENCE
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State | RI
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Zip | 02908-3738
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Country | US
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Telephone | 617-237-6169
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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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 |
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