Provider Demographics
NPI:1831060730
Name:RODRIGUEZ, LISETH STEFANNY (LSW)
Entity type:Individual
Prefix:
First Name:LISETH
Middle Name:STEFANNY
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 HOWARD BLVD STE J
Mailing Address - Street 2:
Mailing Address - City:MOUNT ARLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07856-2314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:181 HOWARD BLVD STE J
Practice Address - Street 2:
Practice Address - City:MOUNT ARLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07856-2314
Practice Address - Country:US
Practice Address - Phone:862-803-9262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL073161001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical