Provider Demographics
NPI:1922435999
Name:CAROLINE RODRIGUEZ PROFESSIONAL PSYCHOLOGIST, P.S.C.
Entity Type:Organization
Organization Name:CAROLINE RODRIGUEZ PROFESSIONAL PSYCHOLOGIST, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-690-0311
Mailing Address - Street 1:1106 CALLE REY JUAN CARLOS
Mailing Address - Street 2:CONDOMINIO QUINTA REAL
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-2100
Mailing Address - Country:US
Mailing Address - Phone:787-690-0311
Mailing Address - Fax:
Practice Address - Street 1:312 DE DIEGO AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00909-1756
Practice Address - Country:US
Practice Address - Phone:787-690-0311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2145261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service