Provider Demographics
NPI:1861906497
Name:RODRIGUEZ, VENAE NOLAN (MSW)
Entity type:Individual
Prefix:
First Name:VENAE
Middle Name:NOLAN
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 NE SUMNER ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-8066
Mailing Address - Country:US
Mailing Address - Phone:503-484-8045
Mailing Address - Fax:
Practice Address - Street 1:3737 NE SUMNER ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-8066
Practice Address - Country:US
Practice Address - Phone:503-208-5007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-17
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA46531041C0700X
ORL83621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical