Provider Demographics
NPI:1093952707
Name:RODRIGUEZ, PENELOPE L (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:PENELOPE
Middle Name:L
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11204
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96721-6204
Mailing Address - Country:US
Mailing Address - Phone:808-936-9221
Mailing Address - Fax:
Practice Address - Street 1:32 KINOOLE ST
Practice Address - Street 2:SUITE 103
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2469
Practice Address - Country:US
Practice Address - Phone:808-936-9221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-16
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI230101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health