Provider Demographics
NPI:1750846127
Name:RODRIGUEZ, EDWARDO SALVADOR JR (LCSW)
Entity type:Individual
Prefix:
First Name:EDWARDO
Middle Name:SALVADOR
Last Name:RODRIGUEZ
Suffix:JR
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 1:4914 SCARSDALE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78744-2944
Mailing Address - Country:US
Mailing Address - Phone:575-312-7006
Mailing Address - Fax:
Practice Address - Street 1:2600 W STASSNEY LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-3401
Practice Address - Country:US
Practice Address - Phone:214-945-1168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-09
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1066201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical