Provider Demographics
NPI:1548484454
Name:RODSTROM, BRENDA PIGGINS (LCSW)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:PIGGINS
Last Name:RODSTROM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W 91ST ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-1321
Mailing Address - Country:US
Mailing Address - Phone:917-441-2999
Mailing Address - Fax:917-441-8228
Practice Address - Street 1:19 W 34TH ST
Practice Address - Street 2:PH
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3006
Practice Address - Country:US
Practice Address - Phone:917-441-2999
Practice Address - Fax:917-441-8228
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072397-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical