Provider Demographics
NPI:1275673774
Name:MENOUTIS-RODRIGUEZ, CATHERINE (MSW, CSW)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:
Last Name:MENOUTIS-RODRIGUEZ
Suffix:
Gender:F
Credentials:MSW, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 KENSINGTON RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-2741
Mailing Address - Country:US
Mailing Address - Phone:516-746-1709
Mailing Address - Fax:516-739-1367
Practice Address - Street 1:101 KENSINGTON RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-2741
Practice Address - Country:US
Practice Address - Phone:516-746-1709
Practice Address - Fax:516-739-1367
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0558821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP3512969OtherOXFORD PIN #
NY7343567OtherVALUE OPTIONS PIN#