Provider Demographics
NPI:1386350098
Name:RODECKER, MEGAN LEIGH (LMSW)
Entity type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:LEIGH
Last Name:RODECKER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ORCHARD PL
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11778-8654
Mailing Address - Country:US
Mailing Address - Phone:631-662-5825
Mailing Address - Fax:
Practice Address - Street 1:4 ORCHARD PL
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778-8654
Practice Address - Country:US
Practice Address - Phone:631-662-5825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY115869-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker