Provider Demographics
NPI:1487206199
Name:RODRIGUEZ, ALICIA V (LICSW)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:V
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 CALLA ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-1428
Mailing Address - Country:US
Mailing Address - Phone:401-376-3093
Mailing Address - Fax:
Practice Address - Street 1:212 CALLA ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-1428
Practice Address - Country:US
Practice Address - Phone:401-340-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9327-C104100000X
RICSW02347104100000X
RIISW034421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1487206199Medicaid