Provider Demographics
NPI:1881424216
Name:RODRIGUEZ, MARIANA ISAMAR (MA)
Entity type:Individual
Prefix:
First Name:MARIANA
Middle Name:ISAMAR
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 FRANKFORD AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-3602
Mailing Address - Country:US
Mailing Address - Phone:267-996-6605
Mailing Address - Fax:215-831-9887
Practice Address - Street 1:4510 FRANKFORD AVE FL 3
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-3602
Practice Address - Country:US
Practice Address - Phone:267-996-6605
Practice Address - Fax:215-831-9887
Is Sole Proprietor?:No
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor