Provider Demographics
NPI:1598547846
Name:RODRIGUEZ, SHARRAE L (MS MCHC)
Entity Type:Individual
Prefix:
First Name:SHARRAE
Middle Name:L
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MS MCHC
Other - Prefix:
Other - First Name:SHARRAE
Other - Middle Name:L
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS PSYCHOLOGY
Mailing Address - Street 1:804 SANDY DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-4309
Mailing Address - Country:US
Mailing Address - Phone:505-409-9074
Mailing Address - Fax:
Practice Address - Street 1:1052 MAIN ST NE STE D
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-7436
Practice Address - Country:US
Practice Address - Phone:505-864-4140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health