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NPI Code Detail

MEDICARE: MRS. DAYLE RODENBORN LCSW

MEDICARE: MRS. DAYLE RODENBORN 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
1104100000XSocial WorkerACSW 20972CA

General Provider Information

NPI Number : 1568518900
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DAYLE RODENBORN LCSW
Provider Business Mailing Address
First Line : 2618 J ST
Second Line : SUITE 2
City : SACRAMENTO
State : CA
Zip : 95816
Country : US
Telephone Number : 916-905-4398
Fax Number :
Provider Business Practice Location Address
First Line : 280 17TH ST
Second Line :
City : OAKLAND
State : CA
Zip : 94612-4124
Country : US
Telephone Number : 510-238-5020
Fax Number : 510-261-3584
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2007
Last Update Date : 08/27/2012

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