Provider Demographics
NPI:1558695379
Name:RODRIGUEZ, MARIA LUISA (LPC, PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:LUISA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LPC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SLACK CT
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-5775
Mailing Address - Country:US
Mailing Address - Phone:862-268-2417
Mailing Address - Fax:
Practice Address - Street 1:672 US HIGHWAY 202/206 STE 2
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-1747
Practice Address - Country:US
Practice Address - Phone:862-268-2417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-25
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00342400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional