Provider Demographics
NPI:1598235848
Name:RODRIGUEZ, NICOLALITA (LMSW)
Entity Type:Individual
Prefix:
First Name:NICOLALITA
Middle Name:
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 1:2780 DELAWARE AVE STE 2790
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-2748
Mailing Address - Country:US
Mailing Address - Phone:716-931-9031
Mailing Address - Fax:716-768-0017
Practice Address - Street 1:2780 DELAWARE AVE
Practice Address - Street 2:SUITE 2790 KENMORE NY 14217
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1886
Practice Address - Country:US
Practice Address - Phone:716-931-9031
Practice Address - Fax:716-768-0017
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-29
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1032721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical