Provider Demographics
NPI:1902156060
Name:RODRIGUEZ, BLANCA N (MS)
Entity Type:Individual
Prefix:MS
First Name:BLANCA
Middle Name:N
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 S DELEON AVE
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-7733
Mailing Address - Country:US
Mailing Address - Phone:321-264-5000
Mailing Address - Fax:321-264-6449
Practice Address - Street 1:1850 S DELEON AVE
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-7733
Practice Address - Country:US
Practice Address - Phone:321-264-5000
Practice Address - Fax:321-264-6449
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor