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NPI Code Detail

MEDICARE: DR. RODRIC BOONE RHODES PH.D., LCSW

MEDICARE: DR. RODRIC BOONE RHODES PH.D., LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerLCS 21427CA
2103TC0700XClinical PsychologistPSY23704CA

General Provider Information

NPI Number : 1013049790
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RODRIC BOONE RHODES PH.D., LCSW
Provider Business Mailing Address
First Line : 4137 E. 7TH STREET
Second Line :
City : LONG BEACH
State : CA
Zip : 90804-5311
Country : US
Telephone Number : 562-618-0451
Fax Number : 562-433-8152
Provider Business Practice Location Address
First Line : 4137 E. 7TH STREET
Second Line :
City : LONG BEACH
State : CA
Zip : 90804-5311
Country : US
Telephone Number : 562-618-0451
Fax Number : 562-433-8152
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2007
Last Update Date : 03/28/2011

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