Provider Demographics
NPI:1780980144
Name:RODRIGUEZ, CRUZ ANTONIO (LCSW)
Entity type:Individual
Prefix:
First Name:CRUZ
Middle Name:ANTONIO
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 1:407 LINCOLN RD STE 6H
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-3023
Mailing Address - Country:US
Mailing Address - Phone:917-771-2707
Mailing Address - Fax:
Practice Address - Street 1:14221 SW 120TH ST STE 118
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7463
Practice Address - Country:US
Practice Address - Phone:917-771-2707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-02
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY084817-11041C0700X
FLSW135411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022634800Medicaid