Provider Demographics
NPI:1265460596
Name:RODRIGUEZ GUTIERREZ, ELAISA (MSW)
Entity Type:Individual
Prefix:
First Name:ELAISA
Middle Name:
Last Name:RODRIGUEZ GUTIERREZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CHALETS DE ROYAL PALM
Mailing Address - Street 2:APT. 902
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-3027
Mailing Address - Country:US
Mailing Address - Phone:787-995-2700
Mailing Address - Fax:787-995-2706
Practice Address - Street 1:HOSTOS AVE.
Practice Address - Street 2:#431
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-995-2700
Practice Address - Fax:787-995-2706
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR54401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR005-0059Medicare ID - Type UnspecifiedCLINICAL SOCIAL WORKER