Provider Demographics
NPI:1992460646
Name:RODDY, BRENNA KATHLEEN (RBT)
Entity type:Individual
Prefix:
First Name:BRENNA
Middle Name:KATHLEEN
Last Name:RODDY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 WHARTON ST APT C
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-5054
Mailing Address - Country:US
Mailing Address - Phone:410-707-9181
Mailing Address - Fax:
Practice Address - Street 1:3331 STREET RD STE 430
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-2047
Practice Address - Country:US
Practice Address - Phone:267-982-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-07
Last Update Date:2021-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-18-60652106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician