Provider Demographics
NPI:1780188854
Name:RODRIGUEZ, CARLOS RAFAEL (MA)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:RAFAEL
Last Name:RODRIGUEZ
Suffix:
Gender:M
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:B17 CALLE 2
Mailing Address - Street 2:URB COUNTRY ESTATES
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:787-349-1730
Mailing Address - Fax:
Practice Address - Street 1:1436 AVE PAZ GRANELA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-4129
Practice Address - Country:US
Practice Address - Phone:787-428-3062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5868103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling