Provider Demographics
NPI:1336148477
Name:RODRIGUEZ-LORA, NANCY Y (LCSW)
Entity Type:Individual
Prefix:PROF
First Name:NANCY
Middle Name:Y
Last Name:RODRIGUEZ-LORA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65818 HARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-8997
Mailing Address - Country:US
Mailing Address - Phone:574-536-6229
Mailing Address - Fax:574-533-7666
Practice Address - Street 1:400 WEST LINCOLN AVE.
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-4723
Practice Address - Country:US
Practice Address - Phone:574-533-7133
Practice Address - Fax:574-533-7666
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004716A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200535420AMedicaid
IN200535420AMedicaid