Provider Demographics
NPI:1376638593
Name:RODZVILLA, JENNIFER (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:RODZVILLA
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 1:150 OAKLAND AVE
Mailing Address - Street 2:APT. A306
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-3257
Mailing Address - Country:US
Mailing Address - Phone:804-239-9100
Mailing Address - Fax:
Practice Address - Street 1:833 E BUTLER AVE
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-2280
Practice Address - Country:US
Practice Address - Phone:215-340-1500
Practice Address - Fax:215-489-3020
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040063151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945182Medicaid