Provider Demographics
NPI:1114257243
Name:RODRIGUEZ, JUAN (LCSW)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
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:PO BOX 444
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:NC
Mailing Address - Zip Code:28906-0444
Mailing Address - Country:US
Mailing Address - Phone:828-837-0071
Mailing Address - Fax:828-837-5309
Practice Address - Street 1:254 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:HAYESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28904
Practice Address - Country:US
Practice Address - Phone:828-389-1494
Practice Address - Fax:828-389-1343
Is Sole Proprietor?:No
Enumeration Date:2010-01-13
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0080661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1114257243Medicaid
NC1812AOtherBCBS
NC1812AOtherBCBS