Individual
JASON G RODERICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW, LICSW
Contact information
Practice address
35 S ANGELL ST, PROVIDENCE, RI 02906-5206
(401) 439-4159
Mailing address
51 SPRING GARDEN ST, WARWICK, RI 02888-1652
(401) 439-4159
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2601849
DMV
RI
Enumeration date
09/01/2009
Last updated
10/04/2012
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