Provider Demographics
NPI:1639634116
Name:RODRIGUEZ, MEGAN AMELIA
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:AMELIA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MEGAN
Other - Middle Name:AMELIA
Other - Last Name:MORSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:130 CORRIDOR RD UNIT 3292
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32004-7833
Mailing Address - Country:US
Mailing Address - Phone:904-638-6388
Mailing Address - Fax:904-485-8829
Practice Address - Street 1:130 CORRIDOR RD UNIT 3292
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32004-7833
Practice Address - Country:US
Practice Address - Phone:904-638-6388
Practice Address - Fax:904-485-8829
Is Sole Proprietor?:No
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-19-77320106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician