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NPI Code Detail

MEDICARE: MARK W RODERICK

MEDICARE: MARK W RODERICK
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1881581353
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK W RODERICK
Provider Business Mailing Address
First Line : 10 FORBES RD STE 190
Second Line :
City : BRAINTREE
State : MA
Zip : 02184-2622
Country : US
Telephone Number : 781-300-7503
Fax Number :
Provider Business Practice Location Address
First Line : 10 FORBES RD STE 190
Second Line :
City : BRAINTREE
State : MA
Zip : 02184-2622
Country : US
Telephone Number : 781-300-7503
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2025
Last Update Date : 06/18/2025

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