Provider Demographics
NPI:1346352846
Name:RODRIGUEZ, CARMEN L (LMHC)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:L
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:L
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:110 E MESCALERO RD
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-6542
Mailing Address - Country:US
Mailing Address - Phone:575-755-2272
Mailing Address - Fax:575-622-3325
Practice Address - Street 1:110 E MESCALERO RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-6542
Practice Address - Country:US
Practice Address - Phone:575-755-2272
Practice Address - Fax:575-622-3325
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4516101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health