Provider Demographics
NPI:1548046055
Name:RODRIGUEZ, JOVANNY ALEXIS
Entity type:Individual
Prefix:
First Name:JOVANNY
Middle Name:ALEXIS
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1694 CLAY AVE APT 3A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-7979
Mailing Address - Country:US
Mailing Address - Phone:347-691-9461
Mailing Address - Fax:
Practice Address - Street 1:1694 CLAY AVE APT 3A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-7979
Practice Address - Country:US
Practice Address - Phone:347-691-9461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3660114103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst