Provider Demographics
NPI:1417231002
Name:RODRIGUEZ, MARY MICHELLE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:MICHELLE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7420 E SAINT CHARLES RD
Mailing Address - Street 2:APT. A
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-6801
Mailing Address - Country:US
Mailing Address - Phone:573-639-0938
Mailing Address - Fax:
Practice Address - Street 1:7420 E SAINT CHARLES RD
Practice Address - Street 2:APT. A
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-6801
Practice Address - Country:US
Practice Address - Phone:573-639-0938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-01
Last Update Date:2011-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW0040241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical