Provider Demographics
NPI:1215357124
Name:RODRIGUEZ, MAURICE (LMSW)
Entity Type:Individual
Prefix:
First Name:MAURICE
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7704 2ND ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-6755
Mailing Address - Country:US
Mailing Address - Phone:505-897-5700
Mailing Address - Fax:505-897-1010
Practice Address - Street 1:7704 2ND ST NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-6755
Practice Address - Country:US
Practice Address - Phone:505-897-5700
Practice Address - Fax:505-897-1010
Is Sole Proprietor?:No
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-04601104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker