Provider Demographics
NPI:1225395627
Name:RODMAN, BRENDA H (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:H
Last Name:RODMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 S GRAMERCY PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-3638
Mailing Address - Country:US
Mailing Address - Phone:323-219-9919
Mailing Address - Fax:
Practice Address - Street 1:1231 S GRAMERCY PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-3638
Practice Address - Country:US
Practice Address - Phone:323-219-9919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 171601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical