Provider Demographics
NPI:1639389943
Name:RODRIGUES, BERTA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BERTA
Middle Name:
Last Name:RODRIGUES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 868
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-0868
Mailing Address - Country:US
Mailing Address - Phone:973-291-4721
Mailing Address - Fax:
Practice Address - Street 1:868 BOX
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:NJ
Practice Address - Zip Code:07405-0740
Practice Address - Country:US
Practice Address - Phone:973-291-4721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052070001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0169579Medicaid
NJ71-0960328OtherTAX ID
NJ0169579Medicaid
NJ7633182Medicare UPIN
NJ516377Medicare UPIN
NJ100299Medicare PIN
NJN08N31Medicare UPIN
NJP3511950Medicare UPIN
NJ75841-0014Medicare UPIN