Provider Demographics
NPI:1184945768
Name:RODRIGUEZ, JESSICA (MSW-PSYD)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MSW-PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:574 CHALETS DE LA PLAYA
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-9790
Mailing Address - Country:US
Mailing Address - Phone:787-383-5965
Mailing Address - Fax:
Practice Address - Street 1:VA MEDICAL CENTER CALLE CASIA 10
Practice Address - Street 2:DEPARTMENT OF VETERAN AFFAIRS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3201
Practice Address - Country:US
Practice Address - Phone:787-881-0102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-17
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8269103TC0700X
PR70741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical