Provider Demographics
NPI:1003142233
Name:RODRIGUEZ, JOSE ANGEL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:ANGEL
Last Name:RODRIGUEZ
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Gender:M
Credentials:LCSW
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Mailing Address - Street 1:110 W 97TH ST
Mailing Address - Street 2:C/O WILLIAM F. RYAN COMMUNITY HEALTH CENTER
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6450
Mailing Address - Country:US
Mailing Address - Phone:212-749-1820
Mailing Address - Fax:212-932-8323
Practice Address - Street 1:305 EAST 161ST
Practice Address - Street 2:C/O MONTEFIORE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451
Practice Address - Country:US
Practice Address - Phone:718-410-3561
Practice Address - Fax:718-410-3629
Is Sole Proprietor?:No
Enumeration Date:2009-10-22
Last Update Date:2016-06-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY101YP1600X
NY0814801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral