Provider Demographics
NPI:1659967610
Name:RODRIGUEZ, BRIDGETTE STACEY (MS HUMAN SERVICES)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGETTE
Middle Name:STACEY
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MS HUMAN SERVICES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6266 DUPONT STATION CT E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2567
Mailing Address - Country:US
Mailing Address - Phone:904-745-0067
Mailing Address - Fax:904-745-1030
Practice Address - Street 1:6266 DUPONT STATION CT E
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2567
Practice Address - Country:US
Practice Address - Phone:904-745-0067
Practice Address - Fax:904-745-1030
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional