Provider Demographics
NPI:1952663650
Name:RODRIGUEZ, LISA MARIE (MS ED)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARIE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:PALAZZO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS ED
Mailing Address - Street 1:2169 81ST ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-2593
Mailing Address - Country:US
Mailing Address - Phone:917-318-1689
Mailing Address - Fax:
Practice Address - Street 1:2169 81ST ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-2593
Practice Address - Country:US
Practice Address - Phone:917-318-1689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY522068111174400000X
NY002193103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist