Provider Demographics
NPI:1083387286
Name:RODRIGUEZ, JESSICA VICTORIA (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:VICTORIA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WINTERBERRY LN
Mailing Address - Street 2:
Mailing Address - City:BRIARCLIFF MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10510-1750
Mailing Address - Country:US
Mailing Address - Phone:914-646-8818
Mailing Address - Fax:
Practice Address - Street 1:3 WINTERBERRY LN
Practice Address - Street 2:
Practice Address - City:BRIARCLIFF MANOR
Practice Address - State:NY
Practice Address - Zip Code:10510-1750
Practice Address - Country:US
Practice Address - Phone:914-646-8818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080862-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical