Provider Demographics
NPI:1518112770
Name:RODDY, ROSALYN Y OMOLADE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ROSALYN
Middle Name:Y OMOLADE
Last Name:RODDY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:OMOLADE ROSALYN
Other - Middle Name:
Other - Last Name:RODDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:610 16TH ST
Mailing Address - Street 2:STE.504
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-1282
Mailing Address - Country:US
Mailing Address - Phone:510-309-4444
Mailing Address - Fax:
Practice Address - Street 1:610 16TH ST
Practice Address - Street 2:STE.504
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-1282
Practice Address - Country:US
Practice Address - Phone:510-309-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS284841041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical