Provider Demographics
NPI:1184172843
Name:RODRIGUEZ RICARD, STELLA
Entity type:Individual
Prefix:MS
First Name:STELLA
Middle Name:
Last Name:RODRIGUEZ RICARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14373 SW 96TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-8856
Mailing Address - Country:US
Mailing Address - Phone:786-899-3060
Mailing Address - Fax:
Practice Address - Street 1:8300 W FLAGLER ST STE 258C
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-6002
Practice Address - Country:US
Practice Address - Phone:786-633-5171
Practice Address - Fax:786-559-9279
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-12
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110953100Medicaid