Provider Demographics
NPI:1346694734
Name:RODRIGUEZ, MICHELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20203 INDIAN ROSEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3486
Mailing Address - Country:US
Mailing Address - Phone:718-986-2577
Mailing Address - Fax:
Practice Address - Street 1:19337 SHUMARD OAK DR UNIT 101
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-7235
Practice Address - Country:US
Practice Address - Phone:813-693-0654
Practice Address - Fax:813-441-7320
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW105761041C0700X
FLSW142261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIX025Z-PASCOMedicare PIN
FLIX025Y-TPAMedicare PIN