Provider Demographics
NPI:1659740546
Name:RODRIGUEZ, EVA E (LIC)
Entity Type:Individual
Prefix:MS
First Name:EVA
Middle Name:E
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 CALLE PEDRO RUIZ LOPEZ
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-2669
Mailing Address - Country:US
Mailing Address - Phone:787-689-2466
Mailing Address - Fax:
Practice Address - Street 1:213 CALLE PEDRO RUIZ LOPEZ
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-2669
Practice Address - Country:US
Practice Address - Phone:787-689-2466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-21
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR119251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4063197OtherLCSW
PR1659740546OtherLCSW