Provider Demographics
NPI:1144375338
Name:RODRIGUEZ, VIMARY (PSYD)
Entity type:Individual
Prefix:DR
First Name:VIMARY
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12260 GLENMORE DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-7878
Mailing Address - Country:US
Mailing Address - Phone:954-281-4338
Mailing Address - Fax:
Practice Address - Street 1:1500 N UNIVERSITY DR
Practice Address - Street 2:STE 201D
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-8914
Practice Address - Country:US
Practice Address - Phone:954-281-4338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9893103TH0004X
PR2142103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical