Basic Information
| Provider Information | |||||||||
| NPI: | 1003142233 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | ANGEL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 W 97TH ST | ||||||||
| Address2: | C/O WILLIAM F. RYAN COMMUNITY HEALTH CENTER | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100256450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127491820 | ||||||||
| FaxNumber: | 2129328323 | ||||||||
| Practice Location | |||||||||
| Address1: | 305 EAST 161ST | ||||||||
| Address2: | C/O MONTEFIORE | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184103561 | ||||||||
| FaxNumber: | 7184103629 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2009 | ||||||||
| LastUpdateDate: | 06/21/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP1600X | NY | N | Behavioral Health & Social Service Providers | Counselor | Pastoral | 1041C0700X | 081480 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.