Provider Demographics
NPI:1972085991
Name:RODRIGUEZ, LEONOR MARIE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:LEONOR
Middle Name:MARIE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 N VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01002-9770
Mailing Address - Country:US
Mailing Address - Phone:413-478-7922
Mailing Address - Fax:
Practice Address - Street 1:237 N VALLEY RD
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:MA
Practice Address - Zip Code:01002-9770
Practice Address - Country:US
Practice Address - Phone:413-478-7922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1071781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty