Provider Demographics
NPI:1619155975
Name:RODRIGUEZ, MARIE (PSY D)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PRADO ALTO 7TH ST
Mailing Address - Street 2:#L 33
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966
Mailing Address - Country:US
Mailing Address - Phone:787-557-9546
Mailing Address - Fax:
Practice Address - Street 1:EDIFICIO MEDICO STA CRUZ #73 CALLE STA CRUZ SUITE 107C
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-557-9546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-08
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3032103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical