Provider Demographics
NPI:1689975815
Name:RODRIGUEZ, KENIA (CBHCMS)
Entity Type:Individual
Prefix:
First Name:KENIA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:CBHCMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14280 SW 47TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-4320
Mailing Address - Country:US
Mailing Address - Phone:786-728-1460
Mailing Address - Fax:786-452-1200
Practice Address - Street 1:15924 SW 92ND AVE
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-1842
Practice Address - Country:US
Practice Address - Phone:786-728-1460
Practice Address - Fax:786-452-1200
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2021-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014787300Medicaid