Provider Demographics
NPI:1508518390
Name:RODRIGUEZ, MICHAEL ALEX
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALEX
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 GENTRY CT
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-5251
Mailing Address - Country:US
Mailing Address - Phone:609-533-7261
Mailing Address - Fax:
Practice Address - Street 1:206 GENTRY CT
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-5251
Practice Address - Country:US
Practice Address - Phone:908-318-4950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-22
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0958391041C0700X
NJ44SC060572001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical