Provider Demographics
NPI:1174780761
Name:RODMAN, JEFFREY J (MED)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:J
Last Name:RODMAN
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:FRONT ROYAL
Mailing Address - State:VA
Mailing Address - Zip Code:22630-8951
Mailing Address - Country:US
Mailing Address - Phone:540-533-0715
Mailing Address - Fax:
Practice Address - Street 1:264 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-8951
Practice Address - Country:US
Practice Address - Phone:540-533-0715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA070100371101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)