Provider Demographics
NPI:1235565821
Name:RODRIGUEZ, ROSA (MHC PERMIT PENDING)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MHC PERMIT PENDING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14205 ROOSEVELT AVE
Mailing Address - Street 2:APT. 233
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-6045
Mailing Address - Country:US
Mailing Address - Phone:718-461-8790
Mailing Address - Fax:
Practice Address - Street 1:102 PILLING ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-1610
Practice Address - Country:US
Practice Address - Phone:718-602-1000
Practice Address - Fax:718-602-1111
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health