Provider Demographics
NPI:1073689063
Name:RODRIGUEZ, JULIA (LISW LICENSED INDEPE)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LISW LICENSED INDEPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2418 MILES RD SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106
Mailing Address - Country:US
Mailing Address - Phone:505-246-2413
Mailing Address - Fax:505-842-1503
Practice Address - Street 1:2418 MILES RD SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106
Practice Address - Country:US
Practice Address - Phone:505-246-2413
Practice Address - Fax:505-842-1503
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI02591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM98063Medicaid