Provider Demographics
NPI:1700895679
Name:RODRIGUEZ-MILLER, TRACY ANNETTE (LCSW)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:ANNETTE
Last Name:RODRIGUEZ-MILLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:ANNETTE
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1314 E LAS OLAS BLVD # 1809
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2334
Mailing Address - Country:US
Mailing Address - Phone:305-676-4769
Mailing Address - Fax:
Practice Address - Street 1:522 SW 19TH TER
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-1596
Practice Address - Country:US
Practice Address - Phone:305-676-4769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0038321041C0700X
FLSW77661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL767972600Medicaid