Provider Demographics
NPI:1548486608
Name:RODRIQUES, MARTHA LUCIA (MS, CAC)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:LUCIA
Last Name:RODRIQUES
Suffix:
Gender:F
Credentials:MS, CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6041 DREW ST
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34604-8595
Mailing Address - Country:US
Mailing Address - Phone:352-232-1465
Mailing Address - Fax:352-364-0116
Practice Address - Street 1:8374 FOREST OAKS BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-6844
Practice Address - Country:US
Practice Address - Phone:352-573-8000
Practice Address - Fax:352-364-0116
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1044A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)