Provider Demographics
NPI:1790831196
Name:RODRIGUEZ, MARTHA LAURA (LBSW)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:LAURA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 533274
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78553
Mailing Address - Country:US
Mailing Address - Phone:956-423-8263
Mailing Address - Fax:
Practice Address - Street 1:601 W SESAME DR
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-7930
Practice Address - Country:US
Practice Address - Phone:956-423-0130
Practice Address - Fax:956-444-3294
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31729171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172473401OtherPERFORMING PROVIDER NUMBE