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General NPI Number Information
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NPI Number | 1992949192
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Entity Type | Individual
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Provider Name | ANGELINA S RODNER PH.D.
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Gender | Female
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Dates
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Enumeration Date | 05/01/2009
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Last Update Date | 04/04/2013
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Provider Practice Location Address
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Address Line | 505 IRVING AVE UPSTATE CONCUSSION MANAGEMENT PROGRAM
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City | SYRACUSE
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State | NY
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Zip | 13210-1718
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Country | US
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Telephone | 315-464-8986
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Fax | 315-464-2329
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Provider Business Mailing Address
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Address Line | 505 IRVING AVENUE, SUITE 1249D UPSTATE CONCUSSION MANGEMENT PROGRAM
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City | SYRACUSE
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State | NY
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Zip | 13210-2716
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Country | US
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Telephone | 315-464-8986
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Fax | 315-464-2329
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 018084
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License Number State | NY
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