Provider Demographics
NPI:1457412496
Name:RODMAN, JODY ANN (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:ANN
Last Name:RODMAN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 PRINCETON AVE
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3550
Mailing Address - Country:US
Mailing Address - Phone:732-840-0109
Mailing Address - Fax:732-840-0962
Practice Address - Street 1:44 PRINCETON AVE
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3550
Practice Address - Country:US
Practice Address - Phone:732-840-0109
Practice Address - Fax:732-840-0962
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052005001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ086415U5AMedicare ID - Type Unspecified
NJQ31030Medicare UPIN