Provider Demographics
NPI:1730996042
Name:RODRIGUEZ, KIMBERLY JOCELYN (LCSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JOCELYN
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 1:1780 NE 191ST ST APT 502
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-4240
Mailing Address - Country:US
Mailing Address - Phone:786-897-9187
Mailing Address - Fax:
Practice Address - Street 1:1780 NE 191ST ST APT 502
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-4240
Practice Address - Country:US
Practice Address - Phone:786-897-9187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL239691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical