Provider Demographics
NPI:1346363462
Name:RODRIGUEZ, CAROLINE (PSIC)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PSIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1452
Mailing Address - Street 2:
Mailing Address - City:SABANA SECA
Mailing Address - State:PR
Mailing Address - Zip Code:00952-1452
Mailing Address - Country:US
Mailing Address - Phone:787-690-0311
Mailing Address - Fax:
Practice Address - Street 1:AVE. DON PELAYO AA 3, COVADONGA
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-690-0311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2145103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist