Provider Demographics
NPI:1467294652
Name:RODRIQUEZ-FLETCHER CLINICAL SOCIAL WORK SERVICES LLC
Entity type:Organization
Organization Name:RODRIQUEZ-FLETCHER CLINICAL SOCIAL WORK SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:FLETCHER-RODRIQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LICSW IMH-E
Authorized Official - Phone:308-763-9261
Mailing Address - Street 1:PO BOX 651
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301-0651
Mailing Address - Country:US
Mailing Address - Phone:308-763-9261
Mailing Address - Fax:308-761-3990
Practice Address - Street 1:221 E 3RD ST
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-3825
Practice Address - Country:US
Practice Address - Phone:308-763-9261
Practice Address - Fax:308-761-3990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty