Provider Demographics
NPI:1174001028
Name:FROCK, JODI LYNN (RBT-18-61871)
Entity type:Individual
Prefix:MRS
First Name:JODI
Middle Name:LYNN
Last Name:FROCK
Suffix:
Gender:F
Credentials:RBT-18-61871
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16300 OLD EMMITSBURG RD
Mailing Address - Street 2:
Mailing Address - City:EMMITSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21727-7702
Mailing Address - Country:US
Mailing Address - Phone:301-447-5090
Mailing Address - Fax:
Practice Address - Street 1:343 S SETON AVE
Practice Address - Street 2:
Practice Address - City:EMMITSBURG
Practice Address - State:MD
Practice Address - Zip Code:21727-9226
Practice Address - Country:US
Practice Address - Phone:301-447-5090
Practice Address - Fax:301-447-5870
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSRBT-18-61871106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician