Provider Demographics
NPI:1689290207
Name:RODRIGUEZ, NINA-LUCIA (MHC)
Entity Type:Individual
Prefix:
First Name:NINA-LUCIA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 VERNON AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-6058
Mailing Address - Country:US
Mailing Address - Phone:303-601-3284
Mailing Address - Fax:
Practice Address - Street 1:109 VERNON AVE APT 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-6058
Practice Address - Country:US
Practice Address - Phone:303-601-3284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty