Provider Demographics
NPI:1760704704
Name:RODRIGUEZ, ZULMARY (MPSYC)
Entity Type:Individual
Prefix:
First Name:ZULMARY
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MPSYC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 15 BOX 16020
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-9746
Mailing Address - Country:US
Mailing Address - Phone:787-435-5301
Mailing Address - Fax:787-850-1750
Practice Address - Street 1:105 CALLE PADRE RIVERA
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3461
Practice Address - Country:US
Practice Address - Phone:787-850-1750
Practice Address - Fax:787-850-1750
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3450103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling