Provider Demographics
NPI:1174816417
Name:RODRIGUEZ, TAMMY KAYSON (MA)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:KAYSON
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-2246
Mailing Address - Country:US
Mailing Address - Phone:914-420-1678
Mailing Address - Fax:
Practice Address - Street 1:202 HOOKER AVE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-3329
Practice Address - Country:US
Practice Address - Phone:914-420-1678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004779101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health