Provider Demographics
NPI:1710105952
Name:RODRIGUEZ, JOSEPH A (MSW)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:A
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:JOE
Other - Middle Name:
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:2704 EASTERN AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-3607
Mailing Address - Country:US
Mailing Address - Phone:616-241-1665
Mailing Address - Fax:
Practice Address - Street 1:2704 EASTERN AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-3607
Practice Address - Country:US
Practice Address - Phone:616-241-1665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010133251041C0700X
MI4101005262106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist