Provider Demographics
NPI:1457579286
Name:RODRIGUEZ, MIGUEL A (MSW)
Entity type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:A
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2203 RITO MORELL
Mailing Address - Street 2:VILLA GRILLASCA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-0563
Mailing Address - Country:US
Mailing Address - Phone:939-267-7446
Mailing Address - Fax:
Practice Address - Street 1:2203 RITO MORELL
Practice Address - Street 2:VILLA GRILLASCA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-0563
Practice Address - Country:US
Practice Address - Phone:939-267-7446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR73211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical