Provider Demographics
NPI:1255830469
Name:RODRIGUEZ, JEANETTE (LMHC LIMITED PERMIT)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LMHC LIMITED PERMIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7960 68TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-2913
Mailing Address - Country:US
Mailing Address - Phone:917-562-9936
Mailing Address - Fax:
Practice Address - Street 1:10470 QUEENS BLVD STE 2
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3638
Practice Address - Country:US
Practice Address - Phone:718-275-6010
Practice Address - Fax:718-275-6062
Is Sole Proprietor?:No
Enumeration Date:2018-02-03
Last Update Date:2018-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY09426101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health