Provider Demographics
NPI:1639298896
Name:DEAN, RODNEY BRYANT (LCSW)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:BRYANT
Last Name:DEAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 CHEMEKETA ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-4151
Mailing Address - Country:US
Mailing Address - Phone:503-390-1009
Mailing Address - Fax:503-588-9996
Practice Address - Street 1:1340 CHEMEKETA ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4151
Practice Address - Country:US
Practice Address - Phone:503-390-1009
Practice Address - Fax:503-588-9996
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL30371041C0700X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered251S00000XAgenciesCommunity/Behavioral Health