Provider Demographics
NPI:1609236405
Name:RODRIGUEZ, MIGUEL ANTHONY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:ANTHONY
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 BROADWAY
Mailing Address - Street 2:200
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-1609
Mailing Address - Country:US
Mailing Address - Phone:212-951-6866
Mailing Address - Fax:
Practice Address - Street 1:32 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-1609
Practice Address - Country:US
Practice Address - Phone:212-951-6866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-07
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0841811041C0700X
CT0091631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical