Provider Demographics
NPI:1952163446
Name:RODE, DANIEL (CSW)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:RODE
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CAMINO ORO CT
Mailing Address - Street 2:
Mailing Address - City:TIJERAS
Mailing Address - State:NM
Mailing Address - Zip Code:87059-7924
Mailing Address - Country:US
Mailing Address - Phone:850-300-8628
Mailing Address - Fax:
Practice Address - Street 1:1 CAMINO ORO CT
Practice Address - Street 2:
Practice Address - City:TIJERAS
Practice Address - State:NM
Practice Address - Zip Code:87059-7924
Practice Address - Country:US
Practice Address - Phone:706-593-8731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator