Provider Demographics
NPI:1669708905
Name:RODRIGUEZ, LESLIE (MS, LMHC)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 COLLABERG RD
Mailing Address - Street 2:
Mailing Address - City:STONY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10980-3409
Mailing Address - Country:US
Mailing Address - Phone:845-947-0162
Mailing Address - Fax:
Practice Address - Street 1:450 W NYACK RD
Practice Address - Street 2:SUITE 2
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-1754
Practice Address - Country:US
Practice Address - Phone:845-354-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-21
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP73361101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health