Provider Demographics
NPI:1073378972
Name:RODRIGUEZ, MARIA E (CHW)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:E
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02907-2432
Mailing Address - Country:US
Mailing Address - Phone:401-559-7762
Mailing Address - Fax:
Practice Address - Street 1:106 WILSON ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02907-2432
Practice Address - Country:US
Practice Address - Phone:401-559-7762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management