Provider Demographics
NPI:1649377805
Name:RODRIGUEZ, LOURDES MARIA (LCSW)
Entity type:Individual
Prefix:MS
First Name:LOURDES
Middle Name:MARIA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 W 11TH ST
Mailing Address - Street 2:APT 3
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8336
Mailing Address - Country:US
Mailing Address - Phone:305-490-0768
Mailing Address - Fax:
Practice Address - Street 1:110 W 97TH ST WILLIAM F RYAN CHC
Practice Address - Street 2:BEHAVIORAL HEALTH INTEGRATION DEPT.
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6450
Practice Address - Country:US
Practice Address - Phone:212-749-1820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078646-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical