Provider Demographics
NPI:1063211977
Name:RODERIQUES, MANDI LYNNE (RBT)
Entity type:Individual
Prefix:
First Name:MANDI
Middle Name:LYNNE
Last Name:RODERIQUES
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 HARRISON ST APT 2
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02723-2143
Mailing Address - Country:US
Mailing Address - Phone:857-230-4001
Mailing Address - Fax:
Practice Address - Street 1:657 QUARRY ST STE 2
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02723-1021
Practice Address - Country:US
Practice Address - Phone:857-230-4001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst