Provider Demographics
NPI:1699181149
Name:RODRIGUEZ, THERESE PETERS (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:PETERS
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 DETWILER DR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17404-1107
Mailing Address - Country:US
Mailing Address - Phone:301-538-3038
Mailing Address - Fax:
Practice Address - Street 1:1205 DETWILER DR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17404-1107
Practice Address - Country:US
Practice Address - Phone:301-538-3038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-04
Last Update Date:2014-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1275331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical