Provider Demographics
NPI:1811363245
Name:RODRIGUEZ, LAURA E
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:E
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 NORWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08110-1607
Mailing Address - Country:US
Mailing Address - Phone:856-254-7158
Mailing Address - Fax:
Practice Address - Street 1:2212 NORWOOD AVE
Practice Address - Street 2:
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08110-1607
Practice Address - Country:US
Practice Address - Phone:856-254-7158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health