Provider Demographics
NPI:1982626560
Name:RODICK, GREGORY F (LCSW)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:F
Last Name:RODICK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 SPEEDWAY WOODS DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46224-6147
Mailing Address - Country:US
Mailing Address - Phone:317-241-1597
Mailing Address - Fax:317-241-1568
Practice Address - Street 1:419 SPEEDWAY WOODS DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-6147
Practice Address - Country:US
Practice Address - Phone:317-241-1597
Practice Address - Fax:317-241-1568
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001298A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN233580Medicare ID - Type UnspecifiedPROVIDER NUMBER