1598982258 NPI number — RODGERS PSYCHOLOGICAL SERVICES, INC

Table of content: CAMERON C BIONDO MA, LPC, LAC (NPI 1215303391)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598982258 NPI number — RODGERS PSYCHOLOGICAL SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RODGERS PSYCHOLOGICAL SERVICES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598982258
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1772 JAMES AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55105-2115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-229-6962
Provider Business Mailing Address Fax Number:
651-227-8106

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 GRAND AVE
Provider Second Line Business Practice Location Address:
SUITE 215
Provider Business Practice Location Address City Name:
SAINT PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55102-2582
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-229-6962
Provider Business Practice Location Address Fax Number:
651-227-8106
Provider Enumeration Date:
04/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RODGERS
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER, OWNER
Authorized Official Telephone Number:
651-229-6962

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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