Provider Demographics
NPI:1487997383
Name:FREEZE, RODNEY BLAINE (LCSW)
Entity type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:BLAINE
Last Name:FREEZE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
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Mailing Address - Street 1:215 W 92ND ST
Mailing Address - Street 2:#9D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-7444
Mailing Address - Country:US
Mailing Address - Phone:212-496-6941
Mailing Address - Fax:212-769-9337
Practice Address - Street 1:255 W 92ND ST
Practice Address - Street 2:SUITE 2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-7342
Practice Address - Country:US
Practice Address - Phone:212-496-6941
Practice Address - Fax:212-769-9337
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-29
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0383791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN5M752Medicare PIN