Provider Demographics
NPI:1316004476
Name:RODEN, LAURA LEE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LEE
Last Name:RODEN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 E SOUTHERN AVE STE F1
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7626
Mailing Address - Country:US
Mailing Address - Phone:480-899-8474
Mailing Address - Fax:480-899-1527
Practice Address - Street 1:2600 E SOUTHERN AVE STE F1
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7626
Practice Address - Country:US
Practice Address - Phone:480-899-8474
Practice Address - Fax:480-899-1527
Is Sole Proprietor?:No
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-07711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical