Provider Demographics
NPI:1245770841
Name:PERRY, RODERICK
Entity Type:Individual
Prefix:MR
First Name:RODERICK
Middle Name:
Last Name:PERRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 BOOTH RD
Mailing Address - Street 2:STE C&D
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5717
Mailing Address - Country:US
Mailing Address - Phone:386-256-4118
Mailing Address - Fax:
Practice Address - Street 1:208 BOOTH RD
Practice Address - Street 2:STE C&D
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5717
Practice Address - Country:US
Practice Address - Phone:386-256-4118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health