Provider Demographics
NPI:1710766282
Name:DONALD, RODERICK (MSW)
Entity Type:Individual
Prefix:MR
First Name:RODERICK
Middle Name:
Last Name:DONALD
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2924 EL PASO WAY
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-4606
Mailing Address - Country:US
Mailing Address - Phone:510-575-3788
Mailing Address - Fax:
Practice Address - Street 1:2924 EL PASO WAY
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-4606
Practice Address - Country:US
Practice Address - Phone:510-575-3788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker