Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 12753 | MD |
N | 1041C0700X | Clinical Social Worker | DP00941682 | WV |
NPI | 1003034794 |
---|---|
Provider Name | Mr. Rodney Steve Richard |
First Address | Oakland, MD 21550 |
Second Address | Oakland, MD 21550 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2007 |
Last Update Date | 08/07/2007 |