Provider Demographics
NPI:1477954675
Name:RODRIGUEZ, JOANIVETTE (BS PSYCH)
Entity Type:Individual
Prefix:
First Name:JOANIVETTE
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:BS PSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3451 SALAND WAY APT 504
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-0809
Mailing Address - Country:US
Mailing Address - Phone:904-662-0657
Mailing Address - Fax:
Practice Address - Street 1:3451 SALAND WAY APT 504
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246
Practice Address - Country:US
Practice Address - Phone:904-662-0657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling