Provider Demographics
NPI:1740861947
Name:RODRIGUEZ, NOELANI (LCAT, RDMT)
Entity type:Individual
Prefix:MS
First Name:NOELANI
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LCAT, RDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7323 190TH ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1853
Mailing Address - Country:US
Mailing Address - Phone:917-288-7856
Mailing Address - Fax:
Practice Address - Street 1:7323 190TH ST
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1853
Practice Address - Country:US
Practice Address - Phone:917-288-7856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002492-01225600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist