Provider Demographics
NPI:1235705625
Name:RODRIGUEZ, EVELYN MICHELLE (LCSW INTERN)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:MICHELLE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LCSW INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3365 W CRAIG RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-5112
Mailing Address - Country:US
Mailing Address - Phone:702-461-1982
Mailing Address - Fax:
Practice Address - Street 1:3365 W CRAIG RD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-5112
Practice Address - Country:US
Practice Address - Phone:702-461-1982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical