Provider Demographics
NPI:1477067320
Name:RODRIGUEZ, ZADY
Entity Type:Individual
Prefix:
First Name:ZADY
Middle Name:
Last Name:RODRIGUEZ
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 1:431 RIVER ST,
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453
Mailing Address - Country:US
Mailing Address - Phone:781-423-5207
Mailing Address - Fax:
Practice Address - Street 1:431 RIVER ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-5476
Practice Address - Country:US
Practice Address - Phone:781-423-5207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1134107113OtherNHP
MA1134107113OtherMBHP
MA1134107113Medicaid
MA12529OtherHNE
MA71756OtherTUFTS
MA042622756OtherCCA
MAY10086OtherMEDICARE
MA1134107113OtherFALLON
MA1134107113OtherBEACON
MA997303OtherNETWORK HEALTH