Provider Demographics
NPI:1417841693
Name:NUNEZ-RODRIGUEZ, ANI LAURI (LIMITED PERMIT)
Entity type:Individual
Prefix:
First Name:ANI
Middle Name:LAURI
Last Name:NUNEZ-RODRIGUEZ
Suffix:
Gender:F
Credentials:LIMITED PERMIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 MALLORY LN
Mailing Address - Street 2:
Mailing Address - City:PINE BUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12566-6508
Mailing Address - Country:US
Mailing Address - Phone:646-323-8111
Mailing Address - Fax:
Practice Address - Street 1:15 FORTUNE RD W
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-1625
Practice Address - Country:US
Practice Address - Phone:845-490-0794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP133529101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty