Provider Demographics
NPI:1114611258
Name:RODRIGUES, MARISSA AMBER
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:AMBER
Last Name:RODRIGUES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 BRIAR OAK WAY
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-8043
Mailing Address - Country:US
Mailing Address - Phone:386-747-5702
Mailing Address - Fax:
Practice Address - Street 1:310 WAYMONT CT STE 100
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3475
Practice Address - Country:US
Practice Address - Phone:407-635-1979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical