=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982762910
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHEILA G RHODES LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 95 LINCOLN AVE
-----------------------------------------------------
City | NEW ROCHELLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10801-3912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-632-6757
-----------------------------------------------------
Fax | 914-632-4977
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30 LAKEVIEW RD
-----------------------------------------------------
City | SOUTH SALEM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10590-1000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-763-8173
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 074850
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------