Provider Demographics
NPI:1578889978
Name:RODRIGUEZ, ADA GUISELLE CRUZ (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ADA GUISELLE
Middle Name:CRUZ
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10417 GREEN MOUNTAIN CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2456
Mailing Address - Country:US
Mailing Address - Phone:410-730-7938
Mailing Address - Fax:
Practice Address - Street 1:10417 GREEN MOUNTAIN CIR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2456
Practice Address - Country:US
Practice Address - Phone:410-730-7938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04628103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical