Provider Demographics
NPI:1720265812
Name:DISMUKES, RODNEY PAUL (PHD)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:PAUL
Last Name:DISMUKES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-1948
Mailing Address - Country:US
Mailing Address - Phone:781-784-5294
Mailing Address - Fax:
Practice Address - Street 1:19 WALNUT ST
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067-1948
Practice Address - Country:US
Practice Address - Phone:781-784-5294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4693103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical