Provider Demographics
NPI:1285961755
Name:RODIN, SIMONE (PHD)
Entity type:Individual
Prefix:DR
First Name:SIMONE
Middle Name:
Last Name:RODIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1634 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-1809
Mailing Address - Country:US
Mailing Address - Phone:415-458-3358
Mailing Address - Fax:415-482-0313
Practice Address - Street 1:1634 5TH AVE
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-1809
Practice Address - Country:US
Practice Address - Phone:415-458-3358
Practice Address - Fax:415-482-0313
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14624103TC0700X
CAPSY 14624103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent