Provider Demographics
NPI:1417265588
Name:RODRIGUEZ, MIYAN Y (HS-CP)
Entity Type:Individual
Prefix:
First Name:MIYAN
Middle Name:Y
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:HS-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 WILDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01603-1656
Mailing Address - Country:US
Mailing Address - Phone:508-792-6809
Mailing Address - Fax:
Practice Address - Street 1:366 WILDWOOD AVE
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01603-1656
Practice Address - Country:US
Practice Address - Phone:508-792-6809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)