Provider Demographics
NPI:1992949192
Name:RODNER, ANGELINA S (PHD)
Entity type:Individual
Prefix:DR
First Name:ANGELINA
Middle Name:S
Last Name:RODNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 IRVING AVENUE, SUITE 1249D
Mailing Address - Street 2:UPSTATE CONCUSSION MANGEMENT PROGRAM
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2716
Mailing Address - Country:US
Mailing Address - Phone:315-464-8986
Mailing Address - Fax:315-464-2329
Practice Address - Street 1:505 IRVING AVE
Practice Address - Street 2:UPSTATE CONCUSSION MANAGEMENT PROGRAM
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1718
Practice Address - Country:US
Practice Address - Phone:315-464-8986
Practice Address - Fax:315-464-2329
Is Sole Proprietor?:No
Enumeration Date:2009-05-01
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018084103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical