Provider Demographics
NPI:1942026927
Name:DONADIO RODRIGUEZ, MATIAS
Entity type:Individual
Prefix:
First Name:MATIAS
Middle Name:
Last Name:DONADIO RODRIGUEZ
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W 119TH ST APT 13W
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-7149
Mailing Address - Country:US
Mailing Address - Phone:917-494-8869
Mailing Address - Fax:
Practice Address - Street 1:400 W 119TH ST APT 13W
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-7149
Practice Address - Country:US
Practice Address - Phone:917-494-8869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor