Provider Demographics
NPI:1922215789
Name:RODRIGUEZ, JOE LOUIS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOE
Middle Name:LOUIS
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SADORE LN
Mailing Address - Street 2:1X
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-4835
Mailing Address - Country:US
Mailing Address - Phone:646-667-3550
Mailing Address - Fax:914-202-9878
Practice Address - Street 1:2 SADORE LN
Practice Address - Street 2:1X
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-4835
Practice Address - Country:US
Practice Address - Phone:646-667-3550
Practice Address - Fax:914-202-9878
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069525-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY069525-1OtherLCSW LICENSE NUMBER
NYN3L511Medicare ID - Type UnspecifiedPROVIDER NUMBER