Provider Demographics
NPI:1245951482
Name:RODRIGUEZ, BEATRIZ (PHD)
Entity type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:BIA
Other - Middle Name:
Other - Last Name:LIMA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:205 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:FL
Mailing Address - Zip Code:32439-6622
Mailing Address - Country:US
Mailing Address - Phone:850-737-1712
Mailing Address - Fax:
Practice Address - Street 1:3997 COMMONS DR W STE B
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-8444
Practice Address - Country:US
Practice Address - Phone:850-737-1712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84150101YP2500X
FLMH20583101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional