Provider Demographics
NPI:1255503785
Name:RODRIGUEZ, EDWARDO (MSED)
Entity Type:Individual
Prefix:
First Name:EDWARDO
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 322
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-0322
Mailing Address - Country:US
Mailing Address - Phone:845-219-1637
Mailing Address - Fax:845-215-5555
Practice Address - Street 1:15 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-2924
Practice Address - Country:US
Practice Address - Phone:845-219-1637
Practice Address - Fax:845-215-5555
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-25
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004751-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health