Provider Demographics
NPI:1770475576
Name:RODRIGUEZ, SABRINA JADE
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:JADE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 BERGEN ST APT 1A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-8618
Mailing Address - Country:US
Mailing Address - Phone:786-247-9707
Mailing Address - Fax:
Practice Address - Street 1:150 W 28TH ST STE 1402
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6103
Practice Address - Country:US
Practice Address - Phone:904-501-3221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY05-P112177-02221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist