Provider Demographics
NPI:1619289014
Name:RODRIGUEZ, ROSA OMAYRA (BA)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:OMAYRA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 SIMPSON PL
Mailing Address - Street 2:
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-4526
Mailing Address - Country:US
Mailing Address - Phone:646-544-4613
Mailing Address - Fax:
Practice Address - Street 1:260 E 161ST ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-3512
Practice Address - Country:US
Practice Address - Phone:718-292-6622
Practice Address - Fax:718-292-2182
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor