Provider Demographics
NPI:1437648938
Name:RODRIGUEZ, LISANDRA BARBARA (RMHCI)
Entity Type:Individual
Prefix:
First Name:LISANDRA
Middle Name:BARBARA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6620 SW 12TH ST APT 6
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4962
Mailing Address - Country:US
Mailing Address - Phone:786-306-7324
Mailing Address - Fax:
Practice Address - Street 1:9408 SW 87TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2416
Practice Address - Country:US
Practice Address - Phone:407-647-1781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-09
Last Update Date:2024-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH23556101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRODRIGUEZ088Medicaid