Provider Demographics
NPI:1124590567
Name:RODRIGUEZ, KAREN JOCILYN (LMFT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:JOCILYN
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MISS
Other - First Name:KAREN
Other - Middle Name:JOCILYN
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 311
Mailing Address - Street 2:
Mailing Address - City:LOUGHMAN
Mailing Address - State:FL
Mailing Address - Zip Code:33858-0311
Mailing Address - Country:US
Mailing Address - Phone:914-336-1200
Mailing Address - Fax:
Practice Address - Street 1:11000 VICTORIA PARK LN APT 11210
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33896-3222
Practice Address - Country:US
Practice Address - Phone:914-336-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-26
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT4465106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty