Provider Demographics
NPI:1508250218
Name:AIDA RODRIGUEZ LCSW LLC
Entity Type:Organization
Organization Name:AIDA RODRIGUEZ LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:AIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:973-997-6212
Mailing Address - Street 1:990 CEDAR BRIDGE AVE
Mailing Address - Street 2:SUITE B7 PMB 133
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-4159
Mailing Address - Country:US
Mailing Address - Phone:973-997-6212
Mailing Address - Fax:732-746-4201
Practice Address - Street 1:990 CEDAR BRIDGE AVE
Practice Address - Street 2:SUITE B7 PMB 133
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-4159
Practice Address - Country:US
Practice Address - Phone:973-997-6212
Practice Address - Fax:732-746-4201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05454300251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health