Provider Demographics
NPI:1649817156
Name:RODRIGUEZ, EILEEN PERGENTILE (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:PERGENTILE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MS
Other - First Name:EILEEN
Other - Middle Name:L
Other - Last Name:PERGENTILE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:19 ASPEN WAY
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6370
Mailing Address - Country:US
Mailing Address - Phone:973-224-5964
Mailing Address - Fax:
Practice Address - Street 1:50 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-1735
Practice Address - Country:US
Practice Address - Phone:973-625-7007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC047125001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical