Provider Demographics
NPI:1215683404
Name:BOOKARD, RODERICK
Entity type:Individual
Prefix:
First Name:RODERICK
Middle Name:
Last Name:BOOKARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 E BRAEBURN DR
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-3930
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:718 ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CAMDEN-WYOMING
Practice Address - State:DE
Practice Address - Zip Code:19934-5429
Practice Address - Country:US
Practice Address - Phone:302-573-1231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-25
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities