Provider Demographics
NPI:1710183900
Name:NEUGEBAUER, RODA (LCSW)
Entity Type:Individual
Prefix:
First Name:RODA
Middle Name:
Last Name:NEUGEBAUER
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 1:1 BANK ST APT 5B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-5210
Mailing Address - Country:US
Mailing Address - Phone:212-989-1959
Mailing Address - Fax:
Practice Address - Street 1:31 W 10TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8738
Practice Address - Country:US
Practice Address - Phone:212-253-2494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR013643-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR45619Medicare UPIN
NYN07101Medicare ID - Type Unspecified