Provider Demographics
NPI:1629664867
Name:RODRIGUEZ, HENRIQUE R
Entity Type:Individual
Prefix:
First Name:HENRIQUE
Middle Name:R
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1499 CAMELLIA CIR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3616
Mailing Address - Country:US
Mailing Address - Phone:954-554-2501
Mailing Address - Fax:
Practice Address - Street 1:1499 CAMELLIA CIR
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3616
Practice Address - Country:US
Practice Address - Phone:954-554-2501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional