Provider Demographics
NPI:1356741938
Name:RODRIGUES, BELISA
Entity type:Individual
Prefix:
First Name:BELISA
Middle Name:
Last Name:RODRIGUES
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 1:131 CHUBBUCK ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-8736
Mailing Address - Country:US
Mailing Address - Phone:617-477-7330
Mailing Address - Fax:
Practice Address - Street 1:20 EASTBROOK RD
Practice Address - Street 2:SUITE 201
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-2075
Practice Address - Country:US
Practice Address - Phone:781-302-4600
Practice Address - Fax:781-234-1124
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-02
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor