Provider Demographics
NPI:1306377312
Name:RODRIGUEZ, MARTHA D (LMSW)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:D
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 41ST ST
Mailing Address - Street 2:APT 1
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-4916
Mailing Address - Country:US
Mailing Address - Phone:201-463-1723
Mailing Address - Fax:
Practice Address - Street 1:414 41ST ST
Practice Address - Street 2:APT 1
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-4916
Practice Address - Country:US
Practice Address - Phone:201-463-1723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0988381104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker