Provider Demographics
NPI:1518666262
Name:RODRIGUES, KATHLEEN MARIA
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARIA
Last Name:RODRIGUES
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 1:1200 SW 113TH TER APT 202
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-4355
Mailing Address - Country:US
Mailing Address - Phone:407-616-3075
Mailing Address - Fax:
Practice Address - Street 1:1200 SW 113TH TER APT 202
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-4355
Practice Address - Country:US
Practice Address - Phone:407-616-3075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2024MT5137931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical