Provider Demographics
NPI:1902035926
Name:RODRIGUEZ, BRENDA KEENAN (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:KEENAN
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8347 DATUM LN
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-6201
Mailing Address - Country:US
Mailing Address - Phone:315-622-9731
Mailing Address - Fax:
Practice Address - Street 1:8347 DATUM LN
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-6201
Practice Address - Country:US
Practice Address - Phone:315-491-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-12
Last Update Date:2009-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000083106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist