Provider Demographics
NPI:1891299707
Name:RODRIGUEZ, GREYSY JACKELINE (MS, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:GREYSY
Middle Name:JACKELINE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 SW ONAWAY AVENUE
Mailing Address - Street 2:
Mailing Address - City:PSL
Mailing Address - State:FL
Mailing Address - Zip Code:34987-2201
Mailing Address - Country:US
Mailing Address - Phone:772-361-9480
Mailing Address - Fax:
Practice Address - Street 1:2730 SW ONAWAY AVENUE
Practice Address - Street 2:
Practice Address - City:PSL
Practice Address - State:FL
Practice Address - Zip Code:34987-2201
Practice Address - Country:US
Practice Address - Phone:772-361-9480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-23
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14977101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG6AKMOtherFLORIDA BLUE