Provider Demographics
NPI:1366549925
Name:RODWAY, CICELY A (EDD, LCSW, CASAC)
Entity type:Individual
Prefix:DR
First Name:CICELY
Middle Name:A
Last Name:RODWAY
Suffix:
Gender:F
Credentials:EDD, LCSW, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166-05 HIGHLAND AVENUE
Mailing Address - Street 2:L1
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432
Mailing Address - Country:US
Mailing Address - Phone:646-334-2677
Mailing Address - Fax:718-657-2543
Practice Address - Street 1:166-05 HIGHLAND AVENUE
Practice Address - Street 2:APT 8H
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-2604
Practice Address - Country:US
Practice Address - Phone:646-334-2677
Practice Address - Fax:718-657-2543
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20040101YA0400X
NY078970-11041C0700X
NY070004-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical