Provider Demographics
NPI:1457382111
Name:RODRIGUEZ, D. RENEE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:D. RENEE
Middle Name:
Last Name:RODRIGUEZ
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 1:586 HIGH FALLS ROAD EXT
Mailing Address - Street 2:
Mailing Address - City:CATSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12414-5661
Mailing Address - Country:US
Mailing Address - Phone:917-406-2636
Mailing Address - Fax:
Practice Address - Street 1:586 HIGH FALLS ROAD EXT
Practice Address - Street 2:
Practice Address - City:CATSKILL
Practice Address - State:NY
Practice Address - Zip Code:12414-5661
Practice Address - Country:US
Practice Address - Phone:917-406-2636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0703211041C0700X
NY070321-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNN8731OtherMEDICARE