Provider Demographics
NPI:1407303704
Name:RODRIGUEZ, ELIZABETH MARIE (MED)
Entity Type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:MARIE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 LOUIS HENNA BLVD
Mailing Address - Street 2:APT 10104
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-7310
Mailing Address - Country:US
Mailing Address - Phone:225-385-9671
Mailing Address - Fax:
Practice Address - Street 1:650 LOUIS HENNA BLVD
Practice Address - Street 2:APT 10104
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-7310
Practice Address - Country:US
Practice Address - Phone:225-385-9671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-02
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-16-21676103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst