Provider Demographics
NPI:1619183324
Name:RODRIGUEZ, JANICE (SUBSTANCE CONSULER)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:SUBSTANCE CONSULER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 CALLE UN
Mailing Address - Street 2:32-N
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667-1937
Mailing Address - Country:US
Mailing Address - Phone:787-899-1182
Mailing Address - Fax:787-833-1371
Practice Address - Street 1:CENTRO SALUD MENTAL DE MAYAGUEZ
Practice Address - Street 2:410 AVE HOSTOS SUITE 7
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-1522
Practice Address - Country:US
Practice Address - Phone:787-833-0663
Practice Address - Fax:787-833-1371
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR389101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)