1780740761 NPI number — MR. RICHARD ALAN ROHRLICK MSW, LCSW, BCD, ACSW

Table of content: (NPI 1194192070)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780740761 NPI number — MR. RICHARD ALAN ROHRLICK MSW, LCSW, BCD, ACSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROHRLICK
Provider First Name:
RICHARD
Provider Middle Name:
ALAN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW, BCD, ACSW
Provider Gender Code:
M

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:
1780740761
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
801 N DOWNS ST
Provider Second Line Business Mailing Address:
STE. I
Provider Business Mailing Address City Name:
RIDGECREST
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93555-3300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-375-0348
Provider Business Mailing Address Fax Number:
760-375-9818

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 N DOWNS ST
Provider Second Line Business Practice Location Address:
STE. I
Provider Business Practice Location Address City Name:
RIDGECREST
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93555-3300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-375-0348
Provider Business Practice Location Address Fax Number:
760-375-9818
Provider Enumeration Date:
12/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCSW #LCS-7634 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: LCSW #LCS-7634 . This is a "LIC. CLIN. SOC. WORKER #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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