Provider Demographics
NPI:1275847139
Name:RODRIGUEZ, JUDY (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DE HAVEN DRIVE
Mailing Address - Street 2:APT. 303
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-1254
Mailing Address - Country:US
Mailing Address - Phone:914-376-5249
Mailing Address - Fax:914-376-5249
Practice Address - Street 1:100 DEHAVEN DR
Practice Address - Street 2:APT. 303
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10703-1266
Practice Address - Country:US
Practice Address - Phone:914-376-5249
Practice Address - Fax:914-376-5249
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY360734911103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool