Provider Demographics
NPI:1376272583
Name:RODRIGUEZ, ASHLEY R (MSED)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:R
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12632 HAMMOCK POINTE CIR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-8124
Mailing Address - Country:US
Mailing Address - Phone:646-242-1822
Mailing Address - Fax:
Practice Address - Street 1:12632 HAMMOCK POINTE CIR
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-8124
Practice Address - Country:US
Practice Address - Phone:646-242-1822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS1627103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty