Provider Demographics
NPI:1598034415
Name:RODERICK, WILLIAM JAMES (LCSW)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:JAMES
Last Name:RODERICK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:WILLIAM
Other - Middle Name:
Other - Last Name:RODRIGUEZ
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 52284
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-0319
Mailing Address - Country:US
Mailing Address - Phone:941-961-4745
Mailing Address - Fax:
Practice Address - Street 1:5049 RINGWOOD MDWS
Practice Address - Street 2:SUITE A
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34235-2035
Practice Address - Country:US
Practice Address - Phone:941-961-4745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-21
Last Update Date:2016-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054871001041C0700X
FLSW128411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical