Provider Demographics
NPI:1710684246
Name:RODRIGUEZ, MARIA MERCEDES (MA)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:MERCEDES
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 CALLE SIERRA MORENA PMB 184
Mailing Address - Street 2:URB LA CUMBRE
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5574
Mailing Address - Country:US
Mailing Address - Phone:787-932-0102
Mailing Address - Fax:
Practice Address - Street 1:1416 AVE PAZ GRANELA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-4271
Practice Address - Country:US
Practice Address - Phone:787-932-0102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6286103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist