Provider Demographics
NPI:1285865071
Name:RODRIGUEZ, CARMEN JULIA (PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:JULIA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:RIVER PARK
Mailing Address - Street 2:H-205
Mailing Address - City:BAYAMON
Mailing Address - State:PUERTO RICIO
Mailing Address - Zip Code:00961
Mailing Address - Country:UM
Mailing Address - Phone:787-648-2683
Mailing Address - Fax:
Practice Address - Street 1:SIPMA-MUNOZ RIVERA 500
Practice Address - Street 2:233
Practice Address - City:HATO REY
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00918
Practice Address - Country:UM
Practice Address - Phone:787-648-2683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR262103K00000X
PR971103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst