Provider Demographics
NPI:1205322237
Name:RODRIGUEZ, LAURA B (PSYD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:B
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50951
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950-0951
Mailing Address - Country:US
Mailing Address - Phone:787-461-0928
Mailing Address - Fax:
Practice Address - Street 1:N8 CALLE 18
Practice Address - Street 2:URB BRISAS DEL CAMPANERO
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00950
Practice Address - Country:US
Practice Address - Phone:787-461-0928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6129103TA0400X, 103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent