Provider Demographics
NPI:1780122903
Name:RODRIGUEZ, MARGIE (MSW)
Entity type:Individual
Prefix:
First Name:MARGIE
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. VALLE ABAJO FLAMBOYAN
Mailing Address - Street 2:359
Mailing Address - City:COAMO
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00769
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:359 CALLE FLAMBOYAN
Practice Address - Street 2:URBANIZACION VALLE ABAJO
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769-3247
Practice Address - Country:US
Practice Address - Phone:787-204-3495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR111151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR11115Medicare PIN