Provider Demographics
NPI:1740907195
Name:RODRIGUEZ FIGUEROA, CHARLENNE
Entity type:Individual
Prefix:
First Name:CHARLENNE
Middle Name:
Last Name:RODRIGUEZ FIGUEROA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 AVE HOSTOS APT 406
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-4200
Mailing Address - Country:US
Mailing Address - Phone:787-458-0194
Mailing Address - Fax:
Practice Address - Street 1:175 AVE HOSTOS APT 406
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-4200
Practice Address - Country:US
Practice Address - Phone:787-458-0194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-26
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8270103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR498312131OtherPASSPORT