Provider Demographics
NPI:1417063546
Name:RODRIGUEZ, D. PAUL (PHD, LPC, LMHC)
Entity Type:Individual
Prefix:DR
First Name:D.
Middle Name:PAUL
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:PHD, LPC, LMHC
Other - Prefix:DR
Other - First Name:DOUGLAS
Other - Middle Name:P
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 6728
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34290-6728
Mailing Address - Country:US
Mailing Address - Phone:941-564-8734
Mailing Address - Fax:941-876-3452
Practice Address - Street 1:2571 N TOLEDO BLADE BLVD
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34289-9351
Practice Address - Country:US
Practice Address - Phone:941-564-8734
Practice Address - Fax:941-876-3452
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401002109101YP2500X
FLPMH 675101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH9594OtherSTATE OF FL