Provider Demographics
NPI:1356916043
Name:RODRIGUEZ, ELEANOR AGOSTA (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:ELEANOR
Middle Name:AGOSTA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:ELLE
Other - Middle Name:
Other - Last Name:AGOSTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:659 RESTON PL
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33897-1626
Mailing Address - Country:US
Mailing Address - Phone:727-992-0070
Mailing Address - Fax:
Practice Address - Street 1:2113 RUBY RED BLVD STE D
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34714-6115
Practice Address - Country:US
Practice Address - Phone:352-394-0573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-25
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW21921101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL119164700Medicaid