Provider Demographics
NPI:1699514968
Name:RODDENBERRY, BROOKLYN (LCSW)
Entity type:Individual
Prefix:
First Name:BROOKLYN
Middle Name:
Last Name:RODDENBERRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5332 FALLING STAR DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-7823
Mailing Address - Country:US
Mailing Address - Phone:850-519-3928
Mailing Address - Fax:
Practice Address - Street 1:325 JOHN KNOX RD STE 1
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-4166
Practice Address - Country:US
Practice Address - Phone:850-519-3928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW228481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical