Provider Demographics
NPI:1821253287
Name:RODRIGUEZ, ANTONIO III (LICSW, MAC)
Entity Type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:
Last Name:RODRIGUEZ
Suffix:III
Gender:M
Credentials:LICSW, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USAG-DAEGU CCC
Mailing Address - Street 2:UNIT 15746, BOX 865
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96218-5746
Mailing Address - Country:US
Mailing Address - Phone:82108-500-1963
Mailing Address - Fax:
Practice Address - Street 1:UNIT 15746 BOX 865
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96218-5746
Practice Address - Country:US
Practice Address - Phone:82108-500-1963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW71171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical