Provider Demographics
NPI:1316400062
Name:RODRIGUEZ, GERONIMO (CBHCM)
Entity Type:Individual
Prefix:
First Name:GERONIMO
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:CBHCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S FEDERAL HWY STE 835
Mailing Address - Street 2:
Mailing Address - City:DANIA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33004-4374
Mailing Address - Country:US
Mailing Address - Phone:954-613-7683
Mailing Address - Fax:954-613-7693
Practice Address - Street 1:801 S FEDERAL HWY STE 835
Practice Address - Street 2:
Practice Address - City:DANIA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33004-4374
Practice Address - Country:US
Practice Address - Phone:954-613-7683
Practice Address - Fax:954-613-7693
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-10
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker