Provider Demographics
NPI:1487038113
Name:RODRIGUEZ, LILIANET
Entity Type:Individual
Prefix:
First Name:LILIANET
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:URB. LAS AGUILAS CALLE5 D15
Mailing Address - Street 2:
Mailing Address - City:COAMO
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00769
Mailing Address - Country:UM
Mailing Address - Phone:787-202-1123
Mailing Address - Fax:
Practice Address - Street 1:D15 CALLE 5
Practice Address - Street 2:URB LAS AGUILAS
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769
Practice Address - Country:US
Practice Address - Phone:787-202-1123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1562101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor