Provider Demographics
NPI:1083983357
Name:RODRIGUEZ-BARNETT, WILDA (LCSW-R)
Entity Type:Individual
Prefix:MRS
First Name:WILDA
Middle Name:
Last Name:RODRIGUEZ-BARNETT
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 WEIRFIELD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-6113
Mailing Address - Country:US
Mailing Address - Phone:347-471-6176
Mailing Address - Fax:
Practice Address - Street 1:4610 61ST ST
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-5766
Practice Address - Country:US
Practice Address - Phone:347-642-4086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR081354-11041C0700X
NY082166-11041C0700X
NY081354-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical