Provider Demographics
NPI:1750636957
Name:RODRIGUEZ, GRACE D (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:D
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RD4 PLAZA 3
Mailing Address - Street 2:RIO CRISTAL, ENCANTADA
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-6004
Mailing Address - Country:US
Mailing Address - Phone:787-293-4051
Mailing Address - Fax:
Practice Address - Street 1:RD4 PLAZA 3
Practice Address - Street 2:RIO CRISTAL, ENCANTADA
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-6004
Practice Address - Country:US
Practice Address - Phone:787-293-4051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR738103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical