Provider Demographics
NPI:1245724715
Name:RODRIGUEZ, SONIA TERESA (DCC)
Entity type:Individual
Prefix:
First Name:SONIA
Middle Name:TERESA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:DCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5957 BENT PINE DR APT 1137
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-3378
Mailing Address - Country:US
Mailing Address - Phone:787-364-4417
Mailing Address - Fax:
Practice Address - Street 1:3438 W. VINE STREET
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741
Practice Address - Country:US
Practice Address - Phone:407-928-0444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health