Provider Demographics
NPI:1396008751
Name:RODRIGUEZ, MARIETTA (MS ED)
Entity Type:Individual
Prefix:
First Name:MARIETTA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DEVONSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-6129
Mailing Address - Country:US
Mailing Address - Phone:516-798-2198
Mailing Address - Fax:516-798-2198
Practice Address - Street 1:1 DEVONSHIRE RD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-6129
Practice Address - Country:US
Practice Address - Phone:516-798-2198
Practice Address - Fax:516-798-2198
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator