Provider Demographics
NPI:1801455183
Name:RODRIGUEZ, MELANIE ANGELINE (PHDPSY)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:ANGELINE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PHDPSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:CALLE PERSEO 501 CONDOMINIO CENTRO DE ALTAMIRA
Mailing Address - Street 2:SUITE 203
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00920
Mailing Address - Country:US
Mailing Address - Phone:787-675-0663
Mailing Address - Fax:
Practice Address - Street 1:CARR 941 SALIDA BO JAGUAS CALLE SAN ANTONIO FINAL
Practice Address - Street 2:
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778
Practice Address - Country:US
Practice Address - Phone:787-737-2311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6895103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4927068OtherOTHER