Provider Demographics
NPI:1902940331
Name:RODRIGUEZ, JUADAN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JUADAN
Middle Name:
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 1:1130 PELHAM PKWY S
Mailing Address - Street 2:SUITE 3G
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1019
Mailing Address - Country:US
Mailing Address - Phone:347-352-9435
Mailing Address - Fax:347-851-4860
Practice Address - Street 1:1130 PELHAM PKWY S
Practice Address - Street 2:SUITE 3G
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1019
Practice Address - Country:US
Practice Address - Phone:347-352-9435
Practice Address - Fax:347-851-4860
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0757181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical