Provider Demographics
NPI:1265852776
Name:RODRIGUEZ, ALEJANDRO (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 S INTERNATIONAL PKWY STE 2471
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-1696
Mailing Address - Country:US
Mailing Address - Phone:321-578-7378
Mailing Address - Fax:
Practice Address - Street 1:1355 S INTERNATIONAL PKWY STE 2471
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1696
Practice Address - Country:US
Practice Address - Phone:321-578-7378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-23
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15829101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health