Provider Demographics
NPI:1619340171
Name:RODRIGUEZ, STEPHANIE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 HEALTH AVE
Mailing Address - Street 2:APT 3
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-4520
Mailing Address - Country:US
Mailing Address - Phone:401-419-6983
Mailing Address - Fax:
Practice Address - Street 1:1 POSA PL
Practice Address - Street 2:ATTEN: STEPHANIE RODRIGUEZ IN EI
Practice Address - City:DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-2511
Practice Address - Country:US
Practice Address - Phone:774-320-5022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator