Provider Demographics
NPI:1720417538
Name:DOMENECH-RODRIGUEZ, MARILYN (LMHC)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:DOMENECH-RODRIGUEZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 AUTUMN DR
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-5686
Mailing Address - Country:US
Mailing Address - Phone:914-589-1300
Mailing Address - Fax:845-463-3891
Practice Address - Street 1:1285 ROUTE 9
Practice Address - Street 2:SUITE 7B
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-4993
Practice Address - Country:US
Practice Address - Phone:845-632-2939
Practice Address - Fax:845-632-2940
Is Sole Proprietor?:No
Enumeration Date:2013-11-02
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001301101YM0800X
NY261901031101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool