Provider Demographics
NPI:1811192750
Name:RODRIGUEZ, EDNA E (CLINICAL PSYCHOLOGIS)
Entity Type:Individual
Prefix:
First Name:EDNA
Middle Name:E
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:CLINICAL PSYCHOLOGIS
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 364582
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-4582
Mailing Address - Country:US
Mailing Address - Phone:787-755-3290
Mailing Address - Fax:787-755-3290
Practice Address - Street 1:CALLE RONDA A 21
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-755-3290
Practice Address - Fax:787-755-3290
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000739103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist