Provider Demographics
NPI:1437627122
Name:RODRIGUEZ MAURI, LUSY
Entity Type:Individual
Prefix:
First Name:LUSY
Middle Name:
Last Name:RODRIGUEZ MAURI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9980 SW 39TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3955
Mailing Address - Country:US
Mailing Address - Phone:786-682-1704
Mailing Address - Fax:
Practice Address - Street 1:9980 SW 39TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3955
Practice Address - Country:US
Practice Address - Phone:786-682-1704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-12
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018999000Medicaid