Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY23704 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY23704 | CA |
N | 1041C0700X | Clinical Social Worker | LCS 21427 | CA |
NPI | 1013049790 |
---|---|
Provider Name | Dr. Rodric Boone Rhodes |
First Address | Long Beach, CA 90804-5311 |
Second Address | Long Beach, CA 90804-5311 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2007 |
Last Update Date | 28/03/2011 |