Provider Demographics
NPI:1891849519
Name:RODRIGUEZ, DAWN (SOCIAL WOK)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:SOCIAL WOK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 MERRITT AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-4241
Mailing Address - Country:US
Mailing Address - Phone:845-629-2672
Mailing Address - Fax:845-838-7632
Practice Address - Street 1:2094 ALBANY POST RD
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:NY
Practice Address - Zip Code:10548-1454
Practice Address - Country:US
Practice Address - Phone:845-831-2000
Practice Address - Fax:845-831-5326
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY075600-11041C0700X
NY075600104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical