Provider Demographics
NPI:1518027598
Name:RODRIGUEZ, LAVERNE L (LMSW)
Entity Type:Individual
Prefix:MS
First Name:LAVERNE
Middle Name:L
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 635
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:NM
Mailing Address - Zip Code:87567-0635
Mailing Address - Country:US
Mailing Address - Phone:505-753-7895
Mailing Address - Fax:
Practice Address - Street 1:1505 15TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-3000
Practice Address - Country:US
Practice Address - Phone:505-662-3264
Practice Address - Fax:505-662-9707
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-067891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical