Provider Demographics
NPI:1356184238
Name:RODRIGUEZ MARISI, MELANIE
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:RODRIGUEZ MARISI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9730 SW 211TH ST
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-3117
Mailing Address - Country:US
Mailing Address - Phone:786-834-6766
Mailing Address - Fax:
Practice Address - Street 1:9730 SW 211TH ST
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-3117
Practice Address - Country:US
Practice Address - Phone:786-834-6766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-354739106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician