Provider Demographics
NPI:1801031943
Name:RODRIGUEZ, STACY MICHELLE (LMHC)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:MICHELLE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LMHC
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 391535
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-0016
Mailing Address - Country:US
Mailing Address - Phone:617-312-1058
Mailing Address - Fax:
Practice Address - Street 1:675 MASSACHUSETTS AVE
Practice Address - Street 2:11TH FLOOR
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3309
Practice Address - Country:US
Practice Address - Phone:617-312-1058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6642101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health