Provider Demographics
NPI:1720157639
Name:RODRIGUEZ, RUDY R (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RUDY
Middle Name:R
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 E CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-2570
Mailing Address - Country:US
Mailing Address - Phone:828-301-1904
Mailing Address - Fax:
Practice Address - Street 1:218 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2570
Practice Address - Country:US
Practice Address - Phone:283-011-9048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0002381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC72807OtherBCBS-NC
NC6002896Medicaid