Provider Demographics
NPI:1790566065
Name:RODRIGUEZ, INGRID DEBORAH (LCSW)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:DEBORAH
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 CALLE NAPOLES
Mailing Address - Street 2:
Mailing Address - City:NAGUABO
Mailing Address - State:PR
Mailing Address - Zip Code:00718-2825
Mailing Address - Country:US
Mailing Address - Phone:787-914-7833
Mailing Address - Fax:
Practice Address - Street 1:68 CALLE ESTEBAN PADILLA
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-6705
Practice Address - Country:US
Practice Address - Phone:787-914-7833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR90481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical