Provider Demographics
NPI:1033644000
Name:RODRIGUEZ, SUSAN M (MS, LMHC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:M
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 NW 53RD ST APT 163
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-4796
Mailing Address - Country:US
Mailing Address - Phone:786-464-9059
Mailing Address - Fax:786-464-9059
Practice Address - Street 1:8100 NW 53RD ST APT 163
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-4796
Practice Address - Country:US
Practice Address - Phone:786-464-9059
Practice Address - Fax:786-464-9059
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9114101YM0800X
OHE2734101YM0800X
NM5186101YM0800X
OHS16573104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
82-0818496OtherEIN