Provider Demographics
NPI:1336402270
Name:RODNEY, RACQUEL (MA PSYCHOLOGY)
Entity type:Individual
Prefix:
First Name:RACQUEL
Middle Name:
Last Name:RODNEY
Suffix:
Gender:F
Credentials:MA PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 1/2 RECTOR ST
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861
Mailing Address - Country:US
Mailing Address - Phone:561-707-5621
Mailing Address - Fax:732-661-6997
Practice Address - Street 1:116 1/2 RECTOR ST
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861
Practice Address - Country:US
Practice Address - Phone:561-707-5621
Practice Address - Fax:732-661-6997
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1778010174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist