Provider Demographics
NPI:1578681490
Name:RODRIGUEZ, MARTA (LCSW)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 N 27TH ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-4746
Mailing Address - Country:US
Mailing Address - Phone:956-928-1749
Mailing Address - Fax:956-928-0095
Practice Address - Street 1:6101 N 27TH ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-4746
Practice Address - Country:US
Practice Address - Phone:956-928-1749
Practice Address - Fax:956-928-0095
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX158011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8E0554Medicare ID - Type Unspecified