Provider Demographics
NPI:1053648980
Name:RODRIGUEZ, EDWIN (LCSW, CASAC-G)
Entity Type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:LCSW, CASAC-G
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 BROAD ST W APT 6M
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-2153
Mailing Address - Country:US
Mailing Address - Phone:914-882-8383
Mailing Address - Fax:914-699-5727
Practice Address - Street 1:60 BROAD ST W APT 6M
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-2153
Practice Address - Country:US
Practice Address - Phone:914-882-8383
Practice Address - Fax:914-699-5727
Is Sole Proprietor?:No
Enumeration Date:2009-11-13
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081404-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical