Provider Demographics
NPI:1013049790
Name:RHODES, RODRIC BOONE (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:RODRIC
Middle Name:BOONE
Last Name:RHODES
Suffix:
Gender:M
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4137 E. 7TH STREET
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-5311
Mailing Address - Country:US
Mailing Address - Phone:562-618-0451
Mailing Address - Fax:562-433-8152
Practice Address - Street 1:4137 E. 7TH STREET
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-5311
Practice Address - Country:US
Practice Address - Phone:562-618-0451
Practice Address - Fax:562-433-8152
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 214271041C0700X
CAPSY23704103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical