Provider Demographics
NPI:1407215379
Name:RODICH, COURTNIE ILONA
Entity Type:Individual
Prefix:MS
First Name:COURTNIE
Middle Name:ILONA
Last Name:RODICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 SW 27TH AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-4765
Mailing Address - Country:US
Mailing Address - Phone:305-699-8581
Mailing Address - Fax:
Practice Address - Street 1:1221 SW 27TH AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-4765
Practice Address - Country:US
Practice Address - Phone:305-699-8581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-19
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist