Provider Demographics
NPI:1881950855
Name:RODRIGUEZ, GLENDALYS (PSY D)
Entity type:Individual
Prefix:DR
First Name:GLENDALYS
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CAGUAS MILENIO II
Mailing Address - Street 2:124 CALLE VIZCAYA
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-242-6472
Mailing Address - Fax:
Practice Address - Street 1:386 AVE DOMENECH
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3719
Practice Address - Country:US
Practice Address - Phone:787-567-0070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4188103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical