Provider Demographics
NPI:1346618964
Name:RODRIGUES, AMY MARIA
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIA
Last Name:RODRIGUES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71-40 112TH STREET
Mailing Address - Street 2:611
Mailing Address - City:FOREST HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:646-256-9108
Mailing Address - Fax:
Practice Address - Street 1:7140 112TH ST
Practice Address - Street 2:611
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4658
Practice Address - Country:US
Practice Address - Phone:646-256-9108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY067887104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker