Provider Demographics
NPI:1396980199
Name:RODRIGUEZ, MARIA CARMEN (MACCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:CARMEN
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 BETSY ROSS DR
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-4223
Mailing Address - Country:US
Mailing Address - Phone:732-414-6018
Mailing Address - Fax:732-414-6018
Practice Address - Street 1:229 BETSY ROSS DR
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-4223
Practice Address - Country:US
Practice Address - Phone:732-414-6018
Practice Address - Fax:732-414-6018
Is Sole Proprietor?:No
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010596-1235Z00000X
NJ41YS00563000235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist